Pub Date : 2022-08-01Epub Date: 2022-08-21DOI: 10.1080/21681805.2022.2108140
Elin Axén, Johan Stranne, Marianne Månsson, Erik Holmberg, Rebecka Arnsrud Godtman
Objective: We evaluated long-term risk for biochemical recurrence and subsequent prognosis in a population-based cohort.
Material and methods: We used register-based data to evaluate 6 675 consecutive patients having radical prostatectomy in Västra Götaland county in Sweden during 1995-2014. Patients were followed until death or end of study, 31 December 2014. Data were collected from registers on national, regional and local level and linked by means of the Swedish personal identity number. Biochemical recurrence was defined as PSA ≥0.2 ng/ml; failure as hormonal treatment, metastasis or prostate cancer death. Survival analysis was used to estimate time to biochemical recurrence and time to failure after biochemical recurrence for patients with 0 - 2 years, 2-5 years, 5-10 years and >10 years interval to biochemical recurrence, respectively.
Results: A total of 1214 men had biochemical recurrence during follow-up. Biochemical recurrence-free survival was 83% (95% confidence interval [CI] 82-84%), 75% (95% CI 74-77%) and 69% (95% CI 67-71%) at 5, 10 and 15 years, respectively. Cumulative incidence of failure for all patients 15 years after biochemical recurrence was 50% (95% CI 43-55%) in competing risk analysis. The risk of failure after biochemical recurrence was highest among patients having biochemical recurrence within 2 years from surgery. Incomplete data on PSA-history is a limitation.
Conclusions: The risk for biochemical recurrence persists 15 years after surgery. Follow-up should continue as long as treatment would be considered in case of recurrent disease.
目的:我们在以人群为基础的队列中评估生化复发的长期风险和随后的预后。材料和方法:我们使用基于登记的数据评估1995-2014年期间瑞典Västra Götaland县连续6 675例根治性前列腺切除术患者。随访患者至2014年12月31日死亡或研究结束。数据是从国家、区域和地方各级的登记册中收集的,并通过瑞典个人身份号码进行联系。生化复发定义为PSA≥0.2 ng/ml;如激素治疗失败、前列腺癌转移或死亡。采用生存分析分别估计生化复发间隔0 ~ 2年、2 ~ 5年、5 ~ 10年和>10年患者生化复发至生化复发时间和生化复发失败时间。结果:随访期间生化复发1214例。5年、10年和15年的生化无复发生存率分别为83%(95%可信区间[CI] 82-84%)、75% (95% CI 74-77%)和69% (95% CI 67-71%)。在竞争风险分析中,所有患者在生化复发后15年的累积失败率为50% (95% CI 43-55%)。术后2年内生化复发的患者生化复发失败的风险最高。不完整的psa病史数据是一个限制。结论:术后15年生化复发风险持续存在。如果疾病复发,只要考虑治疗,就应继续随访。
{"title":"Biochemical recurrence after radical prostatectomy - a large, comprehensive, population-based study with long follow-up.","authors":"Elin Axén, Johan Stranne, Marianne Månsson, Erik Holmberg, Rebecka Arnsrud Godtman","doi":"10.1080/21681805.2022.2108140","DOIUrl":"https://doi.org/10.1080/21681805.2022.2108140","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated long-term risk for biochemical recurrence and subsequent prognosis in a population-based cohort.</p><p><strong>Material and methods: </strong>We used register-based data to evaluate 6 675 consecutive patients having radical prostatectomy in Västra Götaland county in Sweden during 1995-2014. Patients were followed until death or end of study, 31 December 2014. Data were collected from registers on national, regional and local level and linked by means of the Swedish personal identity number. Biochemical recurrence was defined as PSA ≥0.2 ng/ml; failure as hormonal treatment, metastasis or prostate cancer death. Survival analysis was used to estimate time to biochemical recurrence and time to failure after biochemical recurrence for patients with 0 - 2 years, 2-5 years, 5-10 years and >10 years interval to biochemical recurrence, respectively.</p><p><strong>Results: </strong>A total of 1214 men had biochemical recurrence during follow-up. Biochemical recurrence-free survival was 83% (95% confidence interval [CI] 82-84%), 75% (95% CI 74-77%) and 69% (95% CI 67-71%) at 5, 10 and 15 years, respectively. Cumulative incidence of failure for all patients 15 years after biochemical recurrence was 50% (95% CI 43-55%) in competing risk analysis. The risk of failure after biochemical recurrence was highest among patients having biochemical recurrence within 2 years from surgery. Incomplete data on PSA-history is a limitation.</p><p><strong>Conclusions: </strong>The risk for biochemical recurrence persists 15 years after surgery. Follow-up should continue as long as treatment would be considered in case of recurrent disease.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40433717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-07-06DOI: 10.1080/21681805.2022.2096689
Maria Escolino, Paolo Caione, Mariapina Cerulo, Benedetta Lepore, Annalisa Chiodi, Rachele Borgogni, Ciro Esposito
Urethral duplication is a rare congenital anomaly of the lower urinary tract. The most used classification system was suggested by Effmann [1] in 1976, based on radiological findings. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally [2]. Treatment depends on the type of duplication and comorbidities [3]. We describe an unusual presentation of complete hypoplastic type 2A-2 urethral duplication according to Effmann with bilateral obstructive megaureter and prolonged bladder outlet obstruction, which was managed through Progressive Augmentation by Dilating the Urethra Anterior (PADUA).
{"title":"Urethral duplication with bilateral megaureter and bladder outlet obstruction: unusual case managed by PADUA technique.","authors":"Maria Escolino, Paolo Caione, Mariapina Cerulo, Benedetta Lepore, Annalisa Chiodi, Rachele Borgogni, Ciro Esposito","doi":"10.1080/21681805.2022.2096689","DOIUrl":"https://doi.org/10.1080/21681805.2022.2096689","url":null,"abstract":"Urethral duplication is a rare congenital anomaly of the lower urinary tract. The most used classification system was suggested by Effmann [1] in 1976, based on radiological findings. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally [2]. Treatment depends on the type of duplication and comorbidities [3]. We describe an unusual presentation of complete hypoplastic type 2A-2 urethral duplication according to Effmann with bilateral obstructive megaureter and prolonged bladder outlet obstruction, which was managed through Progressive Augmentation by Dilating the Urethra Anterior (PADUA).","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40485386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-07-09DOI: 10.1080/21681805.2022.2096111
Vagan Barsegian, Inga Kosova
Herpes zoster is caused by the reactivation of Varicella-Zoster virus and is classically characterized by unilateral vesicular rash and burning pain in the dermatomal distribution. Zoster sine herpete represents an atypical course of herpes zoster without skin involvement. The lifetime incidence rate of HZ in the general population is 10–20% [1]. It is known that voiding dysfunctions develop in 4% of HZ patients and are associated with the involvement of sacral dermatomes [2]. Common voiding disorders include dysuria, frequent urination, urinary retention and overflow incontinence. More than 150 cases of HZ-associated voiding dysfunction have been reported; however, no cases of ZSH-associated voiding disorders have been described yet.
{"title":"Zoster sine herpete causing voiding disorders in females.","authors":"Vagan Barsegian, Inga Kosova","doi":"10.1080/21681805.2022.2096111","DOIUrl":"https://doi.org/10.1080/21681805.2022.2096111","url":null,"abstract":"Herpes zoster is caused by the reactivation of Varicella-Zoster virus and is classically characterized by unilateral vesicular rash and burning pain in the dermatomal distribution. Zoster sine herpete represents an atypical course of herpes zoster without skin involvement. The lifetime incidence rate of HZ in the general population is 10–20% [1]. It is known that voiding dysfunctions develop in 4% of HZ patients and are associated with the involvement of sacral dermatomes [2]. Common voiding disorders include dysuria, frequent urination, urinary retention and overflow incontinence. More than 150 cases of HZ-associated voiding dysfunction have been reported; however, no cases of ZSH-associated voiding disorders have been described yet.","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40603213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-07-11DOI: 10.1080/21681805.2022.2075923
Karol Axcrona, Sven Löffeler
Almost two decades ago, Wiking Månsson reviewed the state of urological guidelines in an editorial in European Urology titled ‘Evidence-Based Urology – A Utopia?’ [1]. In his article, he posed the question: How are we doing in urology? and provided the rather unflattering answer: Not that good. He lamented that ‘...most of what is published in the urological journals has low level of evidence and as a consequence, low grade of recommendation’. A lot has changed since Månsson voiced his dismay and the change has mostly been for the better. Today, urological guidelines are based on a large number of randomized clinical trials and high-quality register studies. We can, with considerable pride, state that prostate cancer researchers from Scandinavia, with Sweden often in the lead, have made decisive contributions to these improvements. The Scandinavian Prostate Cancer Group (SPCG) has been the incubator of the major Nordic randomized trials, with SPCG-4 and SPCG-7 as the most widely known trials [2,3]. Furthermore, the National Prostate Cancer Register, a Swedish population-based, clinical register, has generated multiple high impact publications [4,5]. Clinical cancer registers are cost-efficient tools to study the often decade-long prostate cancer disease trajectory. In Scandinavia in general and in Sweden in particular, there is a strong scientific environment that has enabled the creation of evidence-based urological cancer guidelines. Clinical guidelines are formulated according to standard procedure, based on a transparent methodology, discussed in professional panels including representatives from other relevant professions and patient organizations. Modern guidelines are largely based on clinical evidence, with prospective randomized control trials having the highest, and retrospective studies from single institutions having the lowest impact. Changes in guidelines can have major implications for patient management, organization of the health care system and on health care economy. However, due to the high level of evidence required for strong recommendations, changes are often slow in the coming. In Europe, most countries adhere to the European Urological Association (EAU) guidelines [6]. While the recommendations in the EAU Guidelines are based on strict rules, the implementation has to be flexible since the health care systems and ‘health care culture’ varies to a certain degree across Europe. In some European countries, urologists and oncologists have adopted EAU guidelines as their own guidelines, while in other countries national guidelines have been issued. In contrast to the EAU guidelines, National guidelines can be written to suit the specific requirements, opportunities and limitations of a national health care system. For the first time a summary of the Swedish prostate cancer guidelines is published in English by Bratt et al. in this issue of the Scandinavian Journal of Urology [7]. Why is it important guidelines written by Swedi
{"title":"A Norwegian perspective on the Swedish national guidelines on prostate cancer for non-metastatic disease.","authors":"Karol Axcrona, Sven Löffeler","doi":"10.1080/21681805.2022.2075923","DOIUrl":"https://doi.org/10.1080/21681805.2022.2075923","url":null,"abstract":"Almost two decades ago, Wiking Månsson reviewed the state of urological guidelines in an editorial in European Urology titled ‘Evidence-Based Urology – A Utopia?’ [1]. In his article, he posed the question: How are we doing in urology? and provided the rather unflattering answer: Not that good. He lamented that ‘...most of what is published in the urological journals has low level of evidence and as a consequence, low grade of recommendation’. A lot has changed since Månsson voiced his dismay and the change has mostly been for the better. Today, urological guidelines are based on a large number of randomized clinical trials and high-quality register studies. We can, with considerable pride, state that prostate cancer researchers from Scandinavia, with Sweden often in the lead, have made decisive contributions to these improvements. The Scandinavian Prostate Cancer Group (SPCG) has been the incubator of the major Nordic randomized trials, with SPCG-4 and SPCG-7 as the most widely known trials [2,3]. Furthermore, the National Prostate Cancer Register, a Swedish population-based, clinical register, has generated multiple high impact publications [4,5]. Clinical cancer registers are cost-efficient tools to study the often decade-long prostate cancer disease trajectory. In Scandinavia in general and in Sweden in particular, there is a strong scientific environment that has enabled the creation of evidence-based urological cancer guidelines. Clinical guidelines are formulated according to standard procedure, based on a transparent methodology, discussed in professional panels including representatives from other relevant professions and patient organizations. Modern guidelines are largely based on clinical evidence, with prospective randomized control trials having the highest, and retrospective studies from single institutions having the lowest impact. Changes in guidelines can have major implications for patient management, organization of the health care system and on health care economy. However, due to the high level of evidence required for strong recommendations, changes are often slow in the coming. In Europe, most countries adhere to the European Urological Association (EAU) guidelines [6]. While the recommendations in the EAU Guidelines are based on strict rules, the implementation has to be flexible since the health care systems and ‘health care culture’ varies to a certain degree across Europe. In some European countries, urologists and oncologists have adopted EAU guidelines as their own guidelines, while in other countries national guidelines have been issued. In contrast to the EAU guidelines, National guidelines can be written to suit the specific requirements, opportunities and limitations of a national health care system. For the first time a summary of the Swedish prostate cancer guidelines is published in English by Bratt et al. in this issue of the Scandinavian Journal of Urology [7]. Why is it important guidelines written by Swedi","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-07-11DOI: 10.1080/21681805.2022.2094462
Ola Bratt, Stefan Carlsson, Per Fransson, Camilla Thellenberg Karlsson, Johan Stranne, Jon Kindblom
Objective: There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.
Methods: This is part 1 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. It covers the early detection, diagnostics, staging, patient support and management of the non-metastatic disease. Part 2 covers recurrence after local treatment and management of the metastatic disease.
Results: The 2022 Swedish guidelines include several new recommendations: rectal iodine-povidone to reduce post-biopsy infections, external beam radiation with focal boost to the tumour, use of a pre-rectal spacer to reduce rectal side effects after external beam radiotherapy in some expert centres, 6 months' concomitant and adjuvant rather than neoadjuvant and concomitant hormonal treatment together with radiotherapy for unfavourable intermediate and high-risk disease, and adjuvant abiraterone plus prednisolone together with a GnRH agonist for a subgroup of men with very high-risk disease. The Swedish guidelines differ from the European by having more restrictive recommendations regarding genetic testing and pelvic lymph node dissection, the risk group classification, recommending ultra-hypofractionated (7 fractions) external radiotherapy for intermediate and selected high-risk cancers, by not recommending any hormonal treatment together with radiotherapy for favourable intermediate-risk disease, and by recommending bicalutamide monotherapy instead of a GnRH agonist for some patient groups.
Conclusions: The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.
{"title":"The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease.","authors":"Ola Bratt, Stefan Carlsson, Per Fransson, Camilla Thellenberg Karlsson, Johan Stranne, Jon Kindblom","doi":"10.1080/21681805.2022.2094462","DOIUrl":"https://doi.org/10.1080/21681805.2022.2094462","url":null,"abstract":"<p><strong>Objective: </strong>There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.</p><p><strong>Methods: </strong>This is part 1 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. It covers the early detection, diagnostics, staging, patient support and management of the non-metastatic disease. Part 2 covers recurrence after local treatment and management of the metastatic disease.</p><p><strong>Results: </strong>The 2022 Swedish guidelines include several new recommendations: rectal iodine-povidone to reduce post-biopsy infections, external beam radiation with focal boost to the tumour, use of a pre-rectal spacer to reduce rectal side effects after external beam radiotherapy in some expert centres, 6 months' concomitant and adjuvant rather than neoadjuvant and concomitant hormonal treatment together with radiotherapy for unfavourable intermediate and high-risk disease, and adjuvant abiraterone plus prednisolone together with a GnRH agonist for a subgroup of men with very high-risk disease. The Swedish guidelines differ from the European by having more restrictive recommendations regarding genetic testing and pelvic lymph node dissection, the risk group classification, recommending ultra-hypofractionated (7 fractions) external radiotherapy for intermediate and selected high-risk cancers, by not recommending any hormonal treatment together with radiotherapy for favourable intermediate-risk disease, and by recommending bicalutamide monotherapy instead of a GnRH agonist for some patient groups.</p><p><strong>Conclusions: </strong>The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-08-03DOI: 10.1080/21681805.2022.2107068
Matthias May, Ingmar Wolff, Sabine D Brookman-May, Maximilian Burger
With great interest we have read the excellent manuscript by Møller et al. in which survival rates of patients with bladder cancer (UCB) and primary muscle invasion (primMI) were compared to those of patients with secondary muscle invasion (secMI) [1]. For this purpose, the authors analyzed 650 patients within the Cancer Registry of Norway treated with curative intent from 2008 to 2012. The vast majority underwent radical cystectomy (RC; n1⁄4 556, 86%). In the RC group, 506 patients (91%) had primMI. This relatively high percentage (compared to international literature) was partly explained by the assignment of patients primarily diagnosed with non-muscle-invasive UCB to the primMI group if they progressed to muscle-invasive stage within 4months after initial diagnosis. Within the RC group, cancer-specific mortality (CSM) at 5 years was 42% and 41% for patients with primMI and secMI, respectively, with no significant difference (HR: 0.93, p1⁄4 .78). Available data comparing prognosis of patients with primMI vs. secMI following RC was concisely discussed by Møller et al. and is summarized here again (Table 1) [2–13]. The majority of these studies confirm these findings from Norway showing no differences in survival rates. However, a recent multicentre study of 572 patients undergoing RC without neoadjuvant chemotherapy demonstrated higher 5year-CSM rates for secMI compared to primMI (53.5 vs. 35.5%, p< .001) [12]. In a paper published more than 10 years ago in the Scandinavian Journal of Urology including 607 patients treated with RC for cT1 UCB, we demonstrated a 5-year-CSM of 24% for this group, although slightly more than one third of these patients showed an upstaging in the RC specimen ( pT2,pN0 or pTany,pNþ) [14]. However, it is also undoubted that a general indication for early RC in all patients with high-risk nmiUCB represents an overtreatment in about two-thirds of patients, who persistently survive without tumor progression under conservative therapy [15,16]. Thus, two therapeutic avenues remain to overcome this dilemma. Firstly, more effective conservative therapies for patients with high-risk nmiUCB could result in fewer patients progressing to muscle invasion. Secondly, valid parameters predicting later progression to muscle invasion under conservative therapy for high-risk nmiUCB would allow these patients to be referred to curatively intended therapy (RC or radiochemotherapy) already before secMI becomes evident. Intravesical instillations of Bacillus Calmette-Gu erin (BCG) with up to 3 years of maintenance therapy remain the current therapeutic gold standard for patients with high-risk nmiUCB [15]. Alternatives such as device-assisted intravesical chemotherapy, novel topical drug delivery systems, and systemic application of immune checkpoint inhibitors are currently being tested, although results with longer follow-up are pending [15]. Overall, according to current European Urology Association guidelines, RC is recommended for pa
{"title":"Bladder cancer with secondary muscle invasion - a prognostic dilemma.","authors":"Matthias May, Ingmar Wolff, Sabine D Brookman-May, Maximilian Burger","doi":"10.1080/21681805.2022.2107068","DOIUrl":"https://doi.org/10.1080/21681805.2022.2107068","url":null,"abstract":"With great interest we have read the excellent manuscript by Møller et al. in which survival rates of patients with bladder cancer (UCB) and primary muscle invasion (primMI) were compared to those of patients with secondary muscle invasion (secMI) [1]. For this purpose, the authors analyzed 650 patients within the Cancer Registry of Norway treated with curative intent from 2008 to 2012. The vast majority underwent radical cystectomy (RC; n1⁄4 556, 86%). In the RC group, 506 patients (91%) had primMI. This relatively high percentage (compared to international literature) was partly explained by the assignment of patients primarily diagnosed with non-muscle-invasive UCB to the primMI group if they progressed to muscle-invasive stage within 4months after initial diagnosis. Within the RC group, cancer-specific mortality (CSM) at 5 years was 42% and 41% for patients with primMI and secMI, respectively, with no significant difference (HR: 0.93, p1⁄4 .78). Available data comparing prognosis of patients with primMI vs. secMI following RC was concisely discussed by Møller et al. and is summarized here again (Table 1) [2–13]. The majority of these studies confirm these findings from Norway showing no differences in survival rates. However, a recent multicentre study of 572 patients undergoing RC without neoadjuvant chemotherapy demonstrated higher 5year-CSM rates for secMI compared to primMI (53.5 vs. 35.5%, p< .001) [12]. In a paper published more than 10 years ago in the Scandinavian Journal of Urology including 607 patients treated with RC for cT1 UCB, we demonstrated a 5-year-CSM of 24% for this group, although slightly more than one third of these patients showed an upstaging in the RC specimen ( pT2,pN0 or pTany,pNþ) [14]. However, it is also undoubted that a general indication for early RC in all patients with high-risk nmiUCB represents an overtreatment in about two-thirds of patients, who persistently survive without tumor progression under conservative therapy [15,16]. Thus, two therapeutic avenues remain to overcome this dilemma. Firstly, more effective conservative therapies for patients with high-risk nmiUCB could result in fewer patients progressing to muscle invasion. Secondly, valid parameters predicting later progression to muscle invasion under conservative therapy for high-risk nmiUCB would allow these patients to be referred to curatively intended therapy (RC or radiochemotherapy) already before secMI becomes evident. Intravesical instillations of Bacillus Calmette-Gu erin (BCG) with up to 3 years of maintenance therapy remain the current therapeutic gold standard for patients with high-risk nmiUCB [15]. Alternatives such as device-assisted intravesical chemotherapy, novel topical drug delivery systems, and systemic application of immune checkpoint inhibitors are currently being tested, although results with longer follow-up are pending [15]. Overall, according to current European Urology Association guidelines, RC is recommended for pa","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40691040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-06-29DOI: 10.1080/21681805.2022.2090602
Céline Augé, Nishtman Dizeyi, Lena Ramnemark, Philippe Lluel, Magnus Grabe
Objective: Inflammation of the urinary bladder may cause burdensome pain also called bladder pain syndrome (BPS). A limitation in understanding BPS pathophysiology is the lack of appropriate preclinical model. Previously published clinical and preclinical studies revealed positive impact of Cernitin™ on pain relief in chronic prostatitis. The objective of this study was to evaluate the effects of Cernitin™ on induced inflammation of the urinary bladder in rats. We also sought to identify biomarkers which might play a role in the management of BPS.
Materials and methods: Cystitis was induced by injection of cyclophosphamide (CYP) in female rats. Thereafter, animals were randomly divided into four treatment groups and two control groups. Evaluation of pain scores was assessed by von Frey assay. Expression of pain- and pro-inflammatory biomarkers was determined by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry.
Results: Treatments with Cernitin™ displayed significant anti-nociceptive effects on CYP-induced visceral pain (p < .01). In contrast, vehicle-treated animals showed high pain score even at the lowest force. Furthermore, results of ELISA showed that Cernitin™-treated animals had significantly reduced levels of COX-2 (T60, p < .01; GBX, p < .05) in bladder tissue homogenate. Immunohistochemical (IHC) staining of bladder tissues showed that Cernitin™-treated animals exhibited less CD45-positive cells, while massive CD45-positive cells infiltration was detected in vehicle-treated animals. IHC also revealed lower SP and PGD2 expression levels in Cernitin™-treated tissues.
Conclusions: Cernitin™ components reduced pain score and inflammatory marker COX-2. Our findings suggest a potential therapeutic role for Cernitin™ in the management of BPS.
目的:膀胱炎症可引起严重疼痛,也称为膀胱疼痛综合征(BPS)。了解BPS病理生理的一个限制是缺乏适当的临床前模型。先前发表的临床和临床前研究显示Cernitin™对慢性前列腺炎疼痛缓解有积极作用。本研究的目的是评价Cernitin™对大鼠膀胱诱导炎症的影响。我们还试图确定可能在BPS管理中发挥作用的生物标志物。材料与方法:采用注射环磷酰胺(CYP)诱导雌性大鼠膀胱炎。随后,将动物随机分为4个治疗组和2个对照组。采用von Frey法评估疼痛评分。通过酶联免疫吸附试验(ELISA)和免疫组织化学检测疼痛和促炎生物标志物的表达。结果:Cernitin™治疗对cypp诱导的内脏疼痛具有显著的抗伤害作用(p p p)结论:Cernitin™成分可降低疼痛评分和炎症标志物COX-2。我们的研究结果表明Cernitin™在BPS治疗中具有潜在的治疗作用。
{"title":"Experimental in vivo model to evaluate the impact of Cernitin™ on pain response on induced chronic bladder inflammation.","authors":"Céline Augé, Nishtman Dizeyi, Lena Ramnemark, Philippe Lluel, Magnus Grabe","doi":"10.1080/21681805.2022.2090602","DOIUrl":"https://doi.org/10.1080/21681805.2022.2090602","url":null,"abstract":"<p><strong>Objective: </strong>Inflammation of the urinary bladder may cause burdensome pain also called bladder pain syndrome (BPS). A limitation in understanding BPS pathophysiology is the lack of appropriate preclinical model. Previously published clinical and preclinical studies revealed positive impact of Cernitin™ on pain relief in chronic prostatitis. The objective of this study was to evaluate the effects of Cernitin™ on induced inflammation of the urinary bladder in rats. We also sought to identify biomarkers which might play a role in the management of BPS.</p><p><strong>Materials and methods: </strong>Cystitis was induced by injection of cyclophosphamide (CYP) in female rats. Thereafter, animals were randomly divided into four treatment groups and two control groups. Evaluation of pain scores was assessed by von Frey assay. Expression of pain- and pro-inflammatory biomarkers was determined by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry.</p><p><strong>Results: </strong>Treatments with Cernitin™ displayed significant anti-nociceptive effects on CYP-induced visceral pain (<i>p</i> < .01). In contrast, vehicle-treated animals showed high pain score even at the lowest force. Furthermore, results of ELISA showed that Cernitin™-treated animals had significantly reduced levels of COX-2 (T60, <i>p</i> < .01; GBX, <i>p</i> < .05) in bladder tissue homogenate. Immunohistochemical (IHC) staining of bladder tissues showed that Cernitin™-treated animals exhibited less CD45-positive cells, while massive CD45-positive cells infiltration was detected in vehicle-treated animals. IHC also revealed lower SP and PGD2 expression levels in Cernitin™-treated tissues.</p><p><strong>Conclusions: </strong>Cernitin™ components reduced pain score and inflammatory marker COX-2. Our findings suggest a potential therapeutic role for Cernitin™ in the management of BPS.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40409116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-07-07DOI: 10.1080/21681805.2022.2093396
Ola Bratt, Stefan Carlsson, Per Fransson, Jon Kindblom, Johan Stranne, Camilla Thellenberg Karlsson
Objective: There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.
Methods: This is part 2 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. This part covers recurrence after local treatment and management of metastatic and castration resistant disease. Part 1 covers early detection, diagnostics, staging, patient support and management of non-metastatic disease.
Results: The 2022 Swedish guidelines include several new recommendations. Among these is a recommendation of a period of observation with repeated PSA tests for patients with approximately 10 years' life expectancy who experience a BCR more than 2-5 years after radical prostatectomy, to allow for estimating the PSA doubling time before deciding whether to give salvage radiotherapy or not. Recent results from the PEACE-1 trial led to the recommendation of triple-treatment with a GnRH agonist, abiraterone plus prednisolone and 6 cycles of docetaxel for patients with high-volume metastatic disease who are fit for chemotherapy. The Swedish guidelines differ from the European ones by having more restrictive recommendations about genetic testing of and high-dose zoledronic acid or denosumab treatment for men with metastatic prostate cancer, and by recommending considering bicalutamide monotherapy for selected patients with low-volume metastatic disease.
Conclusions: The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.
{"title":"The Swedish national guidelines on prostate cancer, part 2: recurrent, metastatic and castration resistant disease.","authors":"Ola Bratt, Stefan Carlsson, Per Fransson, Jon Kindblom, Johan Stranne, Camilla Thellenberg Karlsson","doi":"10.1080/21681805.2022.2093396","DOIUrl":"https://doi.org/10.1080/21681805.2022.2093396","url":null,"abstract":"<p><strong>Objective: </strong>There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.</p><p><strong>Methods: </strong>This is part 2 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. This part covers recurrence after local treatment and management of metastatic and castration resistant disease. Part 1 covers early detection, diagnostics, staging, patient support and management of non-metastatic disease.</p><p><strong>Results: </strong>The 2022 Swedish guidelines include several new recommendations. Among these is a recommendation of a period of observation with repeated PSA tests for patients with approximately 10 years' life expectancy who experience a BCR more than 2-5 years after radical prostatectomy, to allow for estimating the PSA doubling time before deciding whether to give salvage radiotherapy or not. Recent results from the PEACE-1 trial led to the recommendation of triple-treatment with a GnRH agonist, abiraterone plus prednisolone and 6 cycles of docetaxel for patients with high-volume metastatic disease who are fit for chemotherapy. The Swedish guidelines differ from the European ones by having more restrictive recommendations about genetic testing of and high-dose zoledronic acid or denosumab treatment for men with metastatic prostate cancer, and by recommending considering bicalutamide monotherapy for selected patients with low-volume metastatic disease.</p><p><strong>Conclusions: </strong>The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40592201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-06-22DOI: 10.1080/21681805.2022.2089228
Harry Nisen, Kaisa Erkkilä, Otto Ettala, Hanna Ronkainen, Taina Isotalo, Timo Nykopp, Heikki Seikkula, Marjo Seppänen, Margus Tramberg, Christian Palmberg, Ansa Kilponen, Dimitri Pogodin-Hannolainen, Sirkku Mustonen, Thea Veitonmäki
Introduction: The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology.
Aims: We applied and validated EAUiaiC, for kidney tumor surgery.
Patients and methods: A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016-2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of ≥3 units of blood (Grade 2) or as ≥5 units (Grade 3), and also by the exclusion of preemptive conversions.
Results: A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (n = 10) and ureter (n = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien-Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%).
Conclusions: The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.
{"title":"Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification.","authors":"Harry Nisen, Kaisa Erkkilä, Otto Ettala, Hanna Ronkainen, Taina Isotalo, Timo Nykopp, Heikki Seikkula, Marjo Seppänen, Margus Tramberg, Christian Palmberg, Ansa Kilponen, Dimitri Pogodin-Hannolainen, Sirkku Mustonen, Thea Veitonmäki","doi":"10.1080/21681805.2022.2089228","DOIUrl":"https://doi.org/10.1080/21681805.2022.2089228","url":null,"abstract":"<p><strong>Introduction: </strong>The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology.</p><p><strong>Aims: </strong>We applied and validated EAUiaiC, for kidney tumor surgery.</p><p><strong>Patients and methods: </strong>A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016-2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of ≥3 units of blood (Grade 2) or as ≥5 units (Grade 3), and also by the exclusion of preemptive conversions.</p><p><strong>Results: </strong>A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (<i>n</i> = 10) and ureter (<i>n</i> = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien-Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%).</p><p><strong>Conclusions: </strong>The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40177652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-08-08DOI: 10.1080/21681805.2022.2108139
Fredrik Stenmark, Lars Brudin, Henrik Kjölhede, Ralph Peeker, Johan Stranne
Introduction: CoreTherm (ProstaLund AB, Lund, Sweden) is an outpatient treatment option in men with lower urinary tract symptoms and catheter-dependent men with chronic urinary retention caused by benign prostatic obstruction (BPO). CoreTherm is high-energy transurethral microwave thermotherapy with feedback technique. Modern treatment with CoreTherm includes transurethral intraprostatic injections of mepivacaine and adrenaline via the Schelin Catheter (ProstaLund AB, Lund, Sweden) and is often referred to as the CoreTherm Concept.
Objectives: The aim of this study was to evaluate the short- and long-term retreatment risk in men with large prostates and BPO or chronic urinary retention, all primarily treated with CoreTherm.
Material and methods: All men from the same geographical area with prostate volumes ≥ 80 ml treated 1999-2015 with CoreTherm and having BPO or were catheter-dependent due to chronic urinary retention, were included. End of study period was defined as December 31, 2019.
Results: We identified and evaluated 570 men treated with CoreTherm, where 12% (71 patients) were surgically retreated during the follow-up. Mean follow-up was 11 years, and maximum follow-up was 20 years. The long-term retreatment rate in our study was 23%. A majority of these could be retreated with CoreTherm or TURP, with only 3% requiring open surgery.
Conclusion: We conclude that CoreTherm is a suitable outpatient treatment option in patients with profoundly enlarged prostates, regardless of age, prostate size, and reason for treatment.
{"title":"Treatment with CoreTherm in 570 patients with prostate volumes of 80-366 ml: an evaluation of short- and long-term retreatment risk.","authors":"Fredrik Stenmark, Lars Brudin, Henrik Kjölhede, Ralph Peeker, Johan Stranne","doi":"10.1080/21681805.2022.2108139","DOIUrl":"https://doi.org/10.1080/21681805.2022.2108139","url":null,"abstract":"<p><strong>Introduction: </strong>CoreTherm (ProstaLund AB, Lund, Sweden) is an outpatient treatment option in men with lower urinary tract symptoms and catheter-dependent men with chronic urinary retention caused by benign prostatic obstruction (BPO). CoreTherm is high-energy transurethral microwave thermotherapy with feedback technique. Modern treatment with CoreTherm includes transurethral intraprostatic injections of mepivacaine and adrenaline <i>via</i> the Schelin Catheter (ProstaLund AB, Lund, Sweden) and is often referred to as the CoreTherm Concept.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate the short- and long-term retreatment risk in men with large prostates and BPO or chronic urinary retention, all primarily treated with CoreTherm.</p><p><strong>Material and methods: </strong>All men from the same geographical area with prostate volumes ≥ 80 ml treated 1999-2015 with CoreTherm and having BPO or were catheter-dependent due to chronic urinary retention, were included. End of study period was defined as December 31, 2019.</p><p><strong>Results: </strong>We identified and evaluated 570 men treated with CoreTherm, where 12% (71 patients) were surgically retreated during the follow-up. Mean follow-up was 11 years, and maximum follow-up was 20 years. The long-term retreatment rate in our study was 23%. A majority of these could be retreated with CoreTherm or TURP, with only 3% requiring open surgery.</p><p><strong>Conclusion: </strong>We conclude that CoreTherm is a suitable outpatient treatment option in patients with profoundly enlarged prostates, regardless of age, prostate size, and reason for treatment.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40692604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}