Scandinavian Journal of Urology最新文献

Objective: To evaluate longitudinal changes in urinary function (UF) and erectile function (EF) in a prospective active surveillance (AS) cohort of men with low-risk prostate cancer (PC), and to correlate urinary and sexual satisfaction with quality of life (QoL).

Material and methods: The final cohort consisted of 359 men from the Finnish arm of the Prostate Cancer Research International: Active Surveillance (PRIAS) trial. Erectile function was assessed using the International Index of Erectile Function (IIEF-15) questionnaire and UF using the International Prostate Symptom Score (IPSS) questionnaire at baseline and at 1, 3, 5, 7, 9, 11, 13, and 15 years. Correlation analyses were performed between EF, UF, and QoL. Factors influencing EF and UF, including age, prostate-specific antigen (PSA), prostate volume, and number of biopsies, were analysed.

Results: In all, 255 (71%) men completed the IIEF-15 and 262 (73%) the IPSS questionnaires at baseline and at least once during follow-up. The median IIEF-15 score at baseline was 56 (interquartile range [IQR] 28-65), decreasing to 42 (IQR 12-62) after 5 years. Median IPSS scores increased from 7 (4-13 IQR) at baseline to 10 (5.5-14.5 IQR) at 3 years. Overall sexual satisfaction and IPSS QoL remained stable throughout follow-up.

Conclusion: AS did not cause short-term disturbances in EF or UF, as measured by standardised IIEF-15 and IPSS questionnaires. Although EF and UF significantly declined over the longest follow-up reported in the literature, overall sexual satisfaction and urinary QoL remained unaffected, suggesting that functional deterioration did not substantially impact patient-perceived QoL during AS.

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Objectives: This study aimed to evaluate the implementation of and adherence to national guidelines at inclusion amongst men with newly diagnosed prostate cancer (PCa) managed with active surveillance (AS) in Norway.

Materials and methods: We conducted a population-based cohort study using data from the Norwegian Prostate Cancer Registry, encompassing all men diagnosed with PCa and managed with AS from 2009 to 2022. We assessed guideline adherence based on AS inclusion criteria defined in the national guidelines and analysed the factors associated with adherence. Non-adherence was defined as inclusion in AS despite not meeting formal criteria.

Results: Among 69,996 men diagnosed with PCa, 11 449 (16.4%) were managed with AS. Overall adherence to national guidelines for AS inclusion was 64%, rising from 60% in 2009 to 77% in 2022, with a notable increase after the 2020 guideline update. Higher adherence was associated with more recent diagnoses, younger age, lower Eastern Cooperative Oncology Group (ECOG) performance status, and evaluation by a private specialist. Significant regional variations in guidelines adherence were observed.

Conclusions: While the use of AS for localised PCa increased in Norway over time, only two in three men were eligible for AS and regional variations persisted. This study highlights the need for strategies to standardise AS implementation across healthcare settings to ensure uniform and evidence-based management of patients with localised PCa nationwide.

Objective: To determine if women aged 50-70 years with a single episode of isolated acute haemorrhagic cystitis have a significantly lower risk of developing urological cancers, potentially indicating that further evaluation for macroscopic haematuria may be unnecessary.

Materials and methods: A retrospective study was conducted on all women assessed for macroscopic haematuria at two participating centres in Sweden between 2020 and 2022. The standard evaluation included computed tomography urography and cystoscopy. Patients were divided into two groups: AHG (acute haemorrhagic cystitis group), which was defined by the presence of macroscopic haematuria and symptoms resembling acute cystitis (dysuria, frequency or urgency), and non-AHG (non-acute haemorrhagic cystitis group), consisting of women with chronic, complicated or recurrent irritative symptoms or no cystitis-like symptoms at all. The characteristics of the women and their tumours were documented.

Results: A total of 1,084 women were evaluated for macroscopic haematuria. The median age was 67 years, with 652 women (60%) aged 50-70. Urological malignancies were detected in 71 women (7%). In the younger group, the AHG had a low cumulative cancer incidence (1%), whereas the non-AHG had a significantly higher rate (10%), P < 0.001. Asymptomatic haematuria showed the highest cumulative cancer incidence (11%). A multivariable Cox regression analysis (for all patients in the study) indicated that women in non-AHG have a seven-fold higher risk of developing urological cancer over time than women in AHG (hazard ratio [HR]: 7.19; 95% confidence interval [CI]: 3.64-14.21; P < 0.001).

Conclusion: Women aged 50-70 years with isolated acute haemorrhagic cystitis have a significantly low risk of urological malignancies, indicating that invasive investigations, such as cystoscopy and computed tomography urography, may not always be necessary. Nonetheless, further large-scale prospective studies are needed to validate these findings.

Objective: The Swedish national guidelines on penile cancer were first published in 2013. The objective of the present study is to present the 2023 update of these guidelines and highlight the differences to the European Association of Urology (EAU) / American Association of Clinical Oncology (ASCO) guidelines on penile cancer.

Material and methods: A review of the literature and a comparison to the EAU / ASCO guideline on penile cancer was performed. Differences between the EAU / ASCO guidelines and the Swedish national guidelines are highlighted.   Results: The Swedish national guidelines on penile cancer emphasized the consultation of a national multidisciplinary treatment conference for all patients diagnosed with both primary and recurrent penile cancer or penile intraepithelial neoplasia (PeIN). Clinically lymph node negative patients diagnosed with >pT1G1 are offered dynamic sentinel node biopsy (DSNB). In the EAU / ASCO guidelines the DSNB is optional for T1aG2 patients. Penile cancer surgery is centralized to two hospitals. Perioperative chemotherapy is offered to patients with ≥N2. In the EAU / ASCO guidelines the use of perioperative chemotherapy for N2 patients is optional. A structured follow-up program is advocated to find recurrences at an early stage.

Conclusions: The Swedish national guidelines on penile cancer have been updated and compared to the EAU / ASCO guidelines. The national multidisciplinary treatment conference, centralization of surgery, the use of perioperative chemotherapy and a structured follow-up are the cornerstones of the Swedish national guidelines on penile cancer.

Background: The role of cystectomy in synchronous oligometastatic bladder cancer is unclear.

Objective: To describe a population-based consecutive cohort with primary oligometastatic bladder cancer (M1a or M1b) treated with curative intent.  Methods: Twenty consecutive patients with primary stage M1a or M1b bladder cancer subjected to induction chemotherapy and radical cystectomy 2013-2024 in the Southern healthcare region were identified in the Swedish National Register for Urinary Bladder Cancer. Primary staging and the evaluation of response to systemic induction chemotherapy were performed using [18F]fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT). After additional chemotherapy, consolidating radical cystectomy, lymphadenectomy and in selected patients, postoperative stereotactic radiotherapy or adjuvant nivolumab were applied. Disease-free survival (DFS) and overall survival (OS) from chemotherapy start were visualised by Kaplan-Meier curves.  Results: Ten patients with retroperitoneal lymph node metastases, seven with single bone metastasis and three with inguinal metastases responding on three chemotherapy courses according to FDG PET-CT-evaluations were subjected to additional chemotherapy and subsequent radical cystectomy and lymphadenectomy with templates including lymph node metastases. Five patients with bone-oligometastatic disease received consolidating stereotactic radiotherapy, and three patients received adjuvant nivolumab. Postoperatively, one patient progressed in preoperatively known bone metastasis, and one patient displayed lack of chemotherapy response in the cystectomy specimen and was consequently subjected to second-line pembrolizumab treatment with palliative intent. At a median follow-up of 23 months, 10  patients (50%) were disease-free.

Conclusions: Long-term survival was observed in some individuals after multimodal treatment for selected patients with synchronous oligometastatic bladder cancer.

Patient summary: Amongst patients diagnosed with limited number of distant bladder cancer metastases, those responding on initial systemic chemotherapy can be selected for further treatment. After additional chemotherapy, radical cystectomy with lymphadenectomy and individually intensified treatment with consolidating radiation towards distant metastases and/or adjuvant systemic treatment with checkpoint inhibitors for 12 months, long-term survival was observed in some individuals despite a disease-entity with bad prognostic features.

Objectives: This capacity and budget impact analysis considers implications of offering a more diversified benign prostate enlargement (BPE) surgical care offering from a healthcare payer perspective in Sweden, Denmark, Norway and Finland.

Methods: A cohort simulation model compares 4-year treatment costs and capacity impact, including hospital bed-days and operating time, with Transurethral Resection of the Prostate (TURP), Holmium Laser Enucleation of the Prostate (HoLEP) using MOSES™Technology, photoselective vaporisation of the prostate (PVP) and Rezūm™ Water Vapour Therapy (WVTT). Current treatment choice is compared to a hypothetical scenario, where TURP-proportion is reduced to 50% and volumes of HoLEP, PVP and WVTT are increased. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) considered uncertainty when varying all model inputs individually and simultaneously.

Results: Reducing the proportion of TURP to 50% and shifting towards a more diversified surgical offering could save 590 bed-days, 2,281 theatre hours and SEK 14,020,153 in Sweden; 343 bed-days, 1,248 theatre hours and DKK 10,493,266 in Denmark; 267 bed-days, 1,032 theatre hours and NOK 9,329,844 in Norway and 576 bed-days, 1,181 theatre hours and 1,059,528€ in Finland per year. WVTT emerged as the lowest-cost procedure in all scenarios. Both DSAs and PSAs demonstrated outcome robustness.

Conclusion: The adoption of a more diversified surgical care offering for patients with BPE in the Nordics may free theatre time and hospital bed-days and create meaningful cost-savings, which off-set higher initial device cost. Economic considerations should not constitute a barrier to the adoption of a patient-centric surgical care offering for BPE patients in the Nordics.

Objective: To investigate the dose-dependent safety and efficacy of using Ethanol 99.5% as a sclerosing agent when treating hydro- and spermatoceles.

Materials and methods: This study (EUDRA-CT 2020-004630-38) was conducted as an open randomised multicentre study where symptomatic hydro- or spermatocele patients were randomised to sclerotherapy with 25- or 50-mL Ethanol 99.5%. The procedure was carried out at four Swedish outpatient clinics. An 8 F pigtail catheter was inserted after local anaesthetics of the skin, the fluid was drained and the randomised dose of Ethanol was instilled. After 30 min, the Ethanol was evacuated. Absorption was measured before and after instillation with a breathalyser and with a blood alcohol test before evacuation. Patients were followed-up by phone on days 1, 2, 3, 4, 30 and 90 after the procedure to capture any complications.

Results: A total of 64 patients were included in this study. None had a significant absorption of alcohol (≥ 0.2‰). The rate of complications was 18%. The number of serious complications needing intervention was 5%. The overall success rate, defined as light or no remaining discomfort, of the treatment regardless of dose was 79%. There was no difference between the different regimens with regards to complications and the success rate, but this study is underpowered in regard to those analysis.

Conclusions: No systemic absorption of Ethanol 99.5% occurred regardless of dose, when used as a sclerosing agent for hydro- and spermatoceles with a 79% cure rate. The efficacy and risks of complications are comparable to other sclerosants.

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Objective: To evaluate oncological and functional outcomes after salvage robotic-assisted laparoscopic radical prostatectomy (sRALP).

Material and methods: We included 60 patients, consecutively treated with sRALP for radiorecurrent prostate cancer (PCa) at Oslo University Hospital (OUS). Data were collected from our PCa registry and electronic patient journal (EPJ). PSA persistence was defined as PSA ≥ 0.1 ng/mL 6 weeks postoperatively, and these patients were not included in the survival analysis. Logistic regression was used to find -variables associated with PSA persistence. Biochemical recurrence (BCR) was defined as PSA ≥ 0.2 ng/mL. Cox regression was used to analyse BCR-free survival. Urinary leakage was graded as minor, moderate or severe. Complications were classified according to the Clavien-Dindo classification.

Results: Twenty-three patients (38%) had persistent PSA. With a median follow-up of 82 months (interquartile range [IQR] 48-101 months), 16 patients (28%) had no BCR or start of androgen deprivation therapy (ADT). Twelve patients (20%) were deceased, 10 (17%) from PCa. Preoperative PSA was statistically significantly associated with persistent PSA (p = 0.01). International Society of Urological Pathology (ISUP) Grade Group 5 showed a statistically significant association with BCR (p = 0.01). Anastomosis leakage and strictures occurred in 27 (45%) and 15 patients (33%), respectively. Twenty-nine patients (48%) suffered severe urinary leakage, whilst 11 patients (24%) had moderate urinary leakage. Eleven patients (18%) received artificial urinary sphincters, and 10 patients (17%) underwent urinary diversion. Two patients suffered a grade 4 complication (sepsis), whilst 25 patients (41%) had grade 3 complications, most of which were related to intervention in the urinary system.  Conclusion: Salvage RALP for radiorecurrent PCa has limited effect on oncological outcomes. Patients should be thoroughly informed about the high risk of urinary leakage and severe surgical complications.