Scandinavian Journal of Urology最新文献

Objective: Combined biopsy (CBx) is a combination of multiparametric magnetic resonance imaging (MpMRI)-targeted prostate biopsy (FBx) and systematic biopsy (SBx). CBx offers highly accurate diagnostic rates, but the increased number of cores taken and the longer procedure time may pose challenges in tolerability compared to traditional biopsies in terms of pain and anxiety. This situation leads to the need to evaluate pain and anxiety.

Methods: In a tertiary hospital in Turkey, 149 patients with suspicious lesions (PI-RADS ≥ 3 on MpMRI) who underwent transrectal CBx were included between May 2023 and August 2023. Following FBx, patients underwent a 12-core systematic biopsy. During CBx, 78 patients listened to classical music, while 71 patients used noise-canceling headphones without music. Ten minutes after the procedure, patients completed the Visual Analog Scale (VAS) and the State-Trait Anxiety Inventory (s-STAI, t-STAI) questionnaires to measure pain and anxiety. s-STAI determines how anxious a person feels at a specific moment. t-STAI indicates the general level of anxiety a person experiences independently of their current situation.

Results: Median VAS score was 3.6 (3.0 - 4.3) in the music group and 5.4 (4.4 - 6.9) in the control group (p < 0.001). The median s-STAI score was 38 (34 - 44) in the music group and 44 (39 - 48) in the control group (p < 0.001). For t-STAI scores, no significant difference between groups was observed.  Conclusion: Incorporating music during CBx, alongside traditional pain management, effectively reduces pain and anxiety levels. Its cost-effectiveness, accessibility, and non-invasive nature make routine use of music during CBx procedures advantageous for pain palliation.

Objective: Transurethral microwave thermotherapy (TUMT) is well described for lower urinary tract symptoms in men with prostates between 30 and 100 grams. We aimed to describe the results in men with prostates larger than 100 grams.

Material and methods: We retrospectively recorded age, prostate size, occurrence of urinary retention, and Danish Prostate Symptom Score (DAN-PSS) prior to treatment in men with prostates exceeding 100 grams. Following treatment, we assessed satisfaction, DAN-PSS, and the results of uroflowmetry and postvoid residual urine.

Results: We included 50 consecutive patients with prostates over 100 g. The median age was 78 years, and the median prostate size was 126 g (range 101-230). Forty-four men were treated due to urinary retention and 6 due to lower urinary tract symptoms. Treatments were performed under local anesthesia. The median duration was 15 minutes (range 8-32 minutes) and the median destruction was 25% of the prostatic volume (range 11-26%). Eight patients had destruction of <20%. No side effects were noted. Forty-nine patients completed 6-month follow-up. The 41/49 (84%) men who had tissue destruction of ≥20% reported to be satisfied. The median DAN-PSS score was 3 (range 0-18), the median Qmax was 12 mL/s (range 5.1-23.1 mL/s) and the median postvoid residual volume was 89 mL (range 0-331 mL). Symptoms were unchanged in the 8/49 (16%) men who had <20% tissue destruction.

Conclusions: TUMT represents a useful alternative to surgery in men with infravesical obstruction and a prostate of more than 100 grams.

Objective: The aim of this study was to evaluate the utilization and impact of emergency computed tomography (CT) on the management of renal colic, focusing on treatment decisions, time to treatment and the subsequent need for additional emergency department (ED) visits.

Materials and methods: Retrospective analysis of patient visits to the ED in Helsingborg with a diagnosis of urolithiasis (ICD codes N20-23) between July 1, 2019 and June 30, 2020.  Results: Out of 64,263 visits, 1.4% (880) visits were related to urolithiasis, involving 612 patients. Emergency CT (within 24 h) was performed in 43% of the cases, with an additional 9% undergoing CT at a subsequent emergency visit. Radiological confirmation of kidney or ureteral stone was found in 324 patients, of which 63% (204) required no treatment. Comparison between patients who underwent emergency CT and those who did not, revealed a significantly shorter time to treatment and closure in the emergency CT group. The median time to treatment was 28 days for those with an emergency CT and 59 days for those without (P < 0.001), acute surgery excluded. The median time to closure was 31 days for emergency CT compared to 37 days without emergency CT (P < 0.010), acute surgery excluded.

Conclusion: In this study, the use of emergency CT shortened the time to treatment and rendered the patient stone free earlier compared to deferred diagnostics, with a note of caution that emergency CT may have led to increased surgical treatments for stones that might otherwise have passed spontaneously.

Clinicaltrials: gov Identifier: NCT06535711.

Objective: Chronic primary prostate pain syndrome (PPPS), usually referred to as chronic prostatitis with chronic pelvic pain syndrome (CP/CPPS), affects approximately 10% of all men. The National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) was developed for clinical assessment and research evaluation of this patient category. The objective of this study was to translate the NIH-CPSI into Swedish, including cross-cultural adaptation and testing it for validity and reliability.  Material and methods: Fifty men with chronic PPPS participated in the testing of a new Swedish questionnaire. The initial translation included forward and backward translation followed by a comprehensive review by an expert committee. The preliminary Swedish translation was tested for face validity and test-retest reliability. In all steps of the translation, both medical experts and laymen participated.  Results: The Swedish translation showed a high degree of consistency with the original version. A few cultural adaptations were jointly agreed upon. The questionnaire was assessed to be clear to understand and having good face validity. The test-retest reliability showed an intraclass correlation (ICC) of 0.89 (95% confidence interval [CI] = 0.82-0.94) which indicates good to excellent reliability. The standard error of measurement and minimal detectable change were 2.5 and 7.0 respectively. A Bland Altman plot showed no systematic difference between test-retest.  Conclusion: This study brings to health care providers and researchers a Swedish version of the internationally recognised NIH-CPSI questionnaire having good validity and reliability, a beneficial addition in the management of men suffering from chronic PPPS in Sweden.

Background: Prostate cancer can be treated with external beam radiation therapy (EBRT) alone or combined with high-dose-rate brachytherapy (HDR-BT+), usually with additional hormonal treatment (HT).  The aim of this long-term cross-sectional study was to compare patient-reported sexual function, hormonal symptoms and quality of life (QoL) after EBRT-only or HDR-BT+.  Methods: In 2016, minimum 5 years after treatment, men treated with HDR-BT+ (n = 248) or EBRT-only (n = 91) responded to a questionnaire containing the Expanded Prostate Cancer Index Composite (EPIC)-26 and the Short Form-12 (SF-12).  Results: Median age at time of answering the questionnaire was 74 years (range 54-86). The majority in the HDR-BT+ group received HT for ≥ 2 years compared to 1/3rd in the EBRT-only group. In crude analyses, the sexual domain summary score (DSS) was significantly higher in the HDR-BT+ compared to the EBRT-only group (32.3 vs. 24.1). All sexual items were significantly better in the HDR-BT+ group except sexual problem. Significantly less fatigue was seen in the HDR-BT+ group despite longer duration of HT. Physical and mental health were similar in both groups.  When adjusted for possible confounders, the differences between treatment groups were no longer statistically significant. Only age was significantly associated with lower sexual scores. Low hormonal DSS was significantly associated with decreased QoL.  Conclusion: Patients treated with HDR-BT+ had not worse long-term sexual function than men treated with EBRT-only. However, this difference disappeared when adjusted for possible confounders. Thus, the interplay of age, HT and fatigue indicates a strong impact on both QoL and sexual function.

Objective: Early and accurate diagnosis of prostate cancer (PC) is crucial for effective treatment. Diagnosing  clinically insignificant cancers can lead to overdiagnosis and overtreatment, highlighting the importance of accurately selecting patients for further evaluation based on improved risk prediction tools. Novel biomarkers offer promise for enhancing this diagnostic process. In this study, we aimed to externally validate a previously developed urine and plasma biomarker test in a biopsy-naïve population.

Materials and methods: Urine and blood samples were prospectively collected from 362 biopsy-naïve men with suspected PC before they underwent transrectal prostate biopsies. The expression levels of a 10-gene mRNA panel were quantified using reverse transcription/quantitative polymerase chain reaction of both urine and plasma. These gene expression levels, combined with clinical features and plasma prostate-specific antigen (PSA) levels, were used to predict the presence of International Society of Urological Pathology grade group ≥ 2 PC.

Results: Complete data were available for 314 patients. The sensitivity and specificity of the biomarker test were 87% (95% CI: 79-93%) and 42% (95% CI: 36-49%), respectively. The area under the curve was 0.76 (95% CI: 0.7-0.82) for the biomarker test probability and 0.65 (95% CI: 0.59-0.72) for PSA (p = 0.02). The test's negative predictive value was 89% (CI: 81-94%).

Conclusion: This study did not replicate the previously reported high accuracy of the biomarker test, highlighting the need for further refinement and robust external validation to ensure reliable performance across diverse patient populations.

Objective: The aim of this study was to evaluate the early experiences of prostate artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).

Material and methods: This retrospective study included all patients treated for BPH who were referred to the radiology department for PAE in Västmanland between 2018 and 2021. Data were collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen level, and peri- and post-procedure outcomes. Clinical success was defined as a decrease in the IPSS by ≤3 points or catheter freedom.

Results: A total of 96 patients (median age 74 years) underwent PAE. Before PAE, 65% of the patients were treated with α-blockers and 83% with 5α-reductase inhibitors. Clinical success was achieved in 60 patients (63%). Among catheterized patients, 33 (53%) achieved catheter freedom. In the non-catheterized group, 27 (79%) experienced clinical success. No significant differences in outcomes were observed based on the presence of a median lobe.

Conclusions: PAE appears to be a viable treatment option for BPH and may provide substantial symptom relief and catheter freedom for most patients. These findings suggest that PAE may be an effective alternative to more invasive procedures. Further research is needed to refine the patient selection criteria.

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Objective: Active surveillance (AS) is recommended for low-risk and some favourable intermediate-risk prostate cancers, but criteria for AS and deferred treatment have changed over time. We assessed time trends for the use of AS and deferred treatment.

Material and methods: Nationwide Swedish register study of 76,191 men diagnosed with low- or intermediate-risk localised prostate cancer from 2008 to 2020. This study presents the proportion of men starting on AS, their clinical characteristics and proportion having deferred treatment. Cox regression was used to calculate hazard ratios for deferred treatment. Subgroup analyses were performed for men < 60 years with Charlson Comorbidity Index 0.

Results: Overall use of AS increased from 2008-2010 to 2017-2020: any low-risk: 40% to 81%, very low-risk disease: 57% to 91%, other low-risk: 37% to 77% and intermediate-risk: 16% to 20%. The relative increase in the use of AS in men < 60 years with Charlson Comorbidity Index 0 was similar to, or greater than, the increase overall. A total of 28,211 men started on AS. The crude proportions of men receiving deferred treatment were relatively stable over time; 2017-2020: very low-risk disease 8%, other low-risk 16% and intermediate-risk 23%. After adjustment for clinical characteristics, deferred treatment within 2 years decreased over time for very low-risk, was stable for other low-risk and increased for intermediate-risk cancer.

Conclusions: The use of AS greatly increased over time, not least amongst younger healthy men, whereas the use of deferred treatment was relatively stable. AS has been increasingly accepted as a safe approach for localised, favourable-risk prostate cancer.