Scandinavian Journal of Urology最新文献

Objective This study aimed to evaluate the association between physical function before surgery and recovery measured as physical activity in daily life after discharge from the hospital. Material and methods In total, 105 patients undergoing robot-assisted radical cystectomy were included, based on preoperative and baseline measurements taken before the intervention from a randomised controlled trial. Physical function was assessed the day before surgery using Six-minute Walk test for functional capacity and 30-second chair stand test for lower body strength. Recovery was evaluated during the week after discharge by measuring daily physical activity, including daily steps, brisk walking, sedentary time, and sit-to-stand transitions, using an accelerometer (activPAL3 micro activity monitor). Multiple regression analysis was performed to evaluate the association, adjusting for age, sex, and American Society of Anaesthesiologists score. Results Analysis included 73 participants with valid measurements for both physical function and recovery. A significant positive association was observed between functional capacity and daily steps, with a 100-meter increase in walking distance associated with approximately 600 additional steps per day (95% CI: 0.53-11.29). The association between functional capacity and sit-to-stand transitions approached significance (β = 0.05; 95% CI: -0.001-0.09). No significant associations were observed between physical function and brisk walking or sedentary time, nor between lower body strength and any recovery outcomes. Conclusions Higher functional capacity is associated with higher recovery levels, as measured by physical activity after hospital discharge using activity monitors. The findings indicate that interventions aimed at improving physical function before robot-assisted radical cystectomy may enhance recovery. Keywords: Abdominal surgery, activity monitor, cancer rehabilitation, physiotherapy, recovery.

Background and objective: Approximately 75% of bladder cancer patients are diagnosed with non-muscle invasive bladder cancer (NMIBC). Complications from treatment, burden the patients and may affect their Quality of Life (QoL). Although accounting for most bladder cancer patients, only 25% of QoL research is conducted in NMIBC patients. The aim is to describe the incidence of complications and to investigate their long-term impact on QoL.

Methods: This is a cross-sectional study using register data combined with a questionnaire, measuring urological, sexual, gastrointestinal, and psychological complications during treatment. The NMIBC patients diagnosed in Denmark from 2015 to 2020 with the ability to receive digital mail were invited to participate along with 1:6 age- and gender-matched controls. The survey mainly consisted of the European Organisation for Research and Treatment of Cancer's (EORTC) EORTC-QLQ-C30 and the NMIBC specific EORTC-QLQ-NMIBC24.

Results: A total of 2262 (43%) NMIBC-patients and their 4092 (36%) matched controls participated. Mean time since last Transurethral Resection of Bladder Tumour was 5.8 years (SD: 2.2). Both cases and controls scored equally on the functional items and symptom items of the EORTC-QLQ-C30. The scoring by NMIBC-patients of the EORTC-QLQ-NMIBC24 were mild, indicating no symptomatology. No difference in register-based diagnoses was identified, except for higher incidences of infections related to the urinary tract identified in NMIBC patients.

Conclusions: We found that NMIBC patients have higher incidences of urological diagnoses compared to controls, but not in sexual or gastrointestinal diagnoses. No difference in long-term impact of complications on QoL between NMIBC patients and controls were identified.

June 4-7th, 2025 Gothenburg, Sweden.

Objective: To evaluate clinical outcome and complications of prostate artery embolization (PAE) in Iceland, using the International Prostate Symptom Score (IPSS), quality of life (QoL) and catheter freedom to measure clinical success.

Materials and methods: Retrospective single-center study, including patients who underwent PAE from August 2019 to February 2024 due to benign prostatic hyperplasia (BPH). Patients completed a questionnaire on lower urinary tract symptoms (LUTS), QoL, catheter status and use of medication. All additional data were retrieved from the medical records.  Results: A total of 34 patients were included, with a mean age of 75 during PAE and a technical success rate of 91%. Patients had significant clinical improvement, with a mean reduction in IPSS score from 20.0 to 9.0 (p < 0.001) and QoL score from 5.5 to 1.8 (p < 0.001). PAE also resulted in a 69% reduction (p < 0.001) in urinary catheter dependency. Post-PAE complications were uncommon (3/34) and all resolved without long-term effects.

Conclusion: PAE is an effective and safe treatment option for LUTS and/or urinary retention in men with BPH, offering catheter freedom and significant improvement in urological symptoms and quality of life.

Objective: Catheter-associated urinary tract infections (CAUTIs) are prevalent healthcare-associated infections, arising from biofilm-forming bacteria. This may be prevented by coating the catheter with an antifouling substance. The novel LubriShield™ Foley catheter is coated with a superhydrophilic surface and a covalently bonded antifouling ligand. Preclinical studies revealed that the coating established a persistent local antifouling environment, inhibiting uropathogenic bacteria from forming biofilms. No substance release has been detected from the coating. The coating achieved a 28-fold reduction in surface friction compared to an uncoated catheter. The aim of this study is to assess the clinical safety of the catheter in patients.

Materials & methods: In a prospective single-centre randomised study, 30 patients undergoing transurethral resection of bladder tumour were enrolled and randomly assigned to receive either a standard control catheter or the novel LubriShield™ catheter. Urinary cultures were obtained twice. The duration of catheterisation for the patients ranged from 3 to 24 h. The primary outcome was the assessment of device-specific adverse events (AEs). Secondary outcomes included evaluations of pain, irritation and discomfort, measured using the Numeric Rating Scale (NRS) (0-10) via a patient questionnaire.

Results: There were no serious adverse events (SAEs) or AEs reported for the coated catheters. Urinary cultures showed no significant differences between the coated and uncoated catheters. Both patients and healthcare professionals rated the NRS equally for the two types of catheters.

Conclusions: The novel-coated LubriShield™ catheter was found to be safe for short-term clinical use.

Objective: To investigate whether department-level use of photodynamic diagnosis (PDD) for primary transurethral bladder resections (TURBs) is associated with recurrence and progression rates in a non-selected, national cohort. Non-muscle invasive bladder cancer (NMIBC) has high global prevalence, and is characterized by high recurrence risk and risk of progression to muscle-invasive bladder cancer. Treatment effects and long-term outcomes rely on diagnostic accuracy, which may be enhanced using PDD for TURB. PDD-use in Denmark has varied between departments.  Material and Methods: We identified all Danish patients with primary NMIBC during 2011-2017 via the Danish National Patient Registry (DNPR) and divided them into four groups based on the treating department's annual PDD use. We included 8,502 patients; 76% men, median age at diagnosis: 70 years (interquartile range [IQR]: 63, 77). Primary outcomes were recurrence- and progression risk differences (RDs) at 2 and 5 years depending on the PDD-exposure group. Results were additionally stratified by baseline pathological risk group.

Results: The PDD-use varied from <40% of primary TURBs in group 1 to >74% in group 4. Overall 2- and 5 years recurrence risks were 39.9% [95% CI: 38.8; 41.0] and 48.1% [95% CI: 46.9; 49.3], while risks of progression were 17.5% [95% CI: 16.7; 18.4] and 22.9% [95% CI: 21.9; 23.9]. PDD-exposure groups 2-4 had lower recurrence- and progression risks compared to group 1, most pronounced for high-risk NMIBC.

Conclusions: PDD-use in primary TURBs correlates with reduced 2- and 5 years recurrence- and progression risks in NMIBC. The PDD benefit was most noticeable in higher risk NMIBC. Photodynamic diagnosis, primary Trans Urethral Resection of the Bladder (TURB), progression risk, recurrence risk.

Objective: For patients diagnosed with muscle-invasive bladder cancer (MIBC), prognosis remains poor with high rates of progression and risk for mortality. To better understand the current treatment landscape, this study aims to describe real-world treatment patterns and clinical outcomes for MIBC patients in Sweden.

Materials and methods: Using population-based registers and electronic medical records, patients with MIBC (T2-4aN0M0) were identified between January 2016 and December 2020 in the Skåne region in Sweden. Patients with de novo MIBC and those who progressed from high-risk nonmuscle-invasive bladder cancer were included. Treatment patterns, overall survival (OS), metastatic rate, event-free survival (EFS), and bladder-intact EFS (BI-EFS) were described.  Results: Among the 231 MIBC patients identified, 34% received only best supportive care (BSC) primarily due to age and comorbidity. Of the 153 patients who received curative treatment, 84 (55%) underwent radical cystectomy (RC) and 69 (45%) received bladder-sparing treatment. Patients who received bladder-sparing treatment were older, had poorer health status, and more comorbidities. Among RC-treated patients, 5-year OS and EFS were 74% (95% confidence interval [CI]: 61-83%) and 70% (95% CI: 58-79%), respectively. Among patients who received bladder-sparing treatment, 5-year OS and BI-EFS were 52% (95% CI: 38-64%) and 34% (95% CI: 21-48%), respectively.

Conclusions: Old age and high rates of comorbidities among the MIBC patient population meant many patients were ineligible for recommended RC and instead received bladder-sparing treatment or BSC only. High rates of progression and poor survival were observed in both patients undergoing RC and patients who received bladder-sparing treatment.

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Objective: This study aimed to describe the regional, population-based, organised prostate cancer testing (OPT) programmes that are being introduced throughout Sweden: motives, structure, target population, diagnostic algorithm, quality control, outcomes, research, and future perspectives.

Results: In 2018, the Swedish National Board of Health and Welfare renewed their recommendation against screening for prostate cancer. Despite this, regional OPT was considered motivated to (1) improve cost-effectiveness compared with unorganised testing, (2) improve equity by giving every man in the target population a chance to make an informed choice, and (3) gain diagnostic and organisational knowledge. The OPT programmes are provided as a regional public healthcare service. They are coordinated by a national working group. The final target population is all men aged 50-74 years. Regional OPT offices use a national administrative system to organise all steps from sending invitation letters to prostate biopsy according to a strict diagnostic algorithm. General practice is involved for blood draw only or not at all. Data are registered in a national register (SweOPT); an annual report is published with the regions' performance on key indicators. At the end of 2024, 16 of the 21 Swedish regions had started OPT and invited 256,000 men with an average cumulative participation rate of 43%. A consortium co-ordinates OPT-related research. A general experience is that communication and organisational matters have been more challenging than medical decisions.

Conclusions: The Swedish population-based OPT programmes provide organisational experiences, diagnostic outcomes, and research results of value for future national prostate cancer screening programmes.

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