Scandinavian Journal of Urology最新文献

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Objective: To report early and late surgical complications following laparoscopic, open and hand-assisted laparoscopic living donor nephrectomy, including duration of sick leave, kidney function and potential risk factors for surgical complications.

Material and methods: Retrospective study on living kidney donors between September 2014 and June 2021 at Rigshopitalet, Copenhagen. Patient data included demographics, comorbidities, surgical information, and postoperative complications (early <30 days and late >30 days). Complications were graded according to Clavien Dindo (CD). Return to work and reasons for prolonged sick leave were recorded. Multivariable logistic regression to identify risk factors for early complications CD ≥ 2 and time-dependent cause specific Cox regression to identify risk factors for late complications.  Results: A total of 223 living donors were included. Early complications were observed in 22% of donors. Early complications were often mild, and the most common complications were pneumonia, wound infection, and urinary retention. Of the 201 donors available for long-term follow-up, 10% experienced a late complication, including incisional port-site hernia and chronic post-surgical pain. 18% reported a prolonged sick leave beyond the planned 6 weeks.  Conclusions: Living donor nephrectomy is associated with a low risk of serious early surgical complications although many will experience minor related complications. As surgical safety has been confirmed in several studies the focus should be on the psychoscial and long-term aspects of living kidney donation to meet donor concerns pre-donation.

Objective: To overview and summarise the Swedish National Guidelines on Urothelial Carcinoma 2024.

Methods: A narrative review of the updated guidelines was performed, highlighting new treatment recommendations for advanced and metastasized disease.  Results: Compared to the previous guideline version, the current update includes recommendations for standardised radiological reporting when urothelial carcinomas are detected at CT-urography (CTU), to early identify locally advanced patients and accelerate the care pathway for these patients. The Swedish guidelines apply a more structured and liberal recommendation for the use of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with locally advanced urothelial carcinomas compared to the EAU-guidelines and recommend such examinations prior to transurethral resection. Improved outcomes for radical cystectomy in Sweden after centralised cystectomy care have led to a recommendation for performing more than six nephroureterectomies (NUs) per year for upper tract urothelial carcinomas (UTUC)-based associations with decreased use of invasive diagnostic modalities and better survival outcomes. Additionally, updated recommendations regarding adjuvant systemic therapies for muscle-invasive disease have been included. Whilst awaiting national regulatory approval for enfortumab vedotin/pembrolizumab, the present guideline version aligns with EAU-guidelines by endorsing cisplatin-gemcitabine-nivolumab as a new first-line treatment option in cisplatin-fit patients with unresectable or metastatic urothelial carcinoma.

Conclusions: The current version of the Swedish national guidelines on urothelial carcinoma introduces standardised reporting at CTU to facilitate early identification of advanced disease, includes recommendations for centralisation of NU for UTUC and updated recommendations for adjuvant systemic treatment of muscle-invasive disease and endorses cisplatin-gemcitabine-nivolumab as a new first-line treatment option for non-resectable locally advanced and metastatic disease.

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Objective: To analyse the budget impact of adopting routine renal tumour biopsy (RTB) prior to decision on surgical treatment for clinical T1 renal tumours in Sweden.

Material and methods: This study used data from the National Swedish Kidney Cancer Register including 4,109 T1N0M0 renal tumours surgically treated during the years 2018-2022. We modelled a gradual increase in the proportion of preoperative RTBs over a five-year period, from 15.6 % of surgically removed clinical T1N0M0 renal tumors up to 90 % preoperative RTBs by 2029. Average costs per patient were calculated primarily using the Swedish cost-per-patient database. The analyses were stratified by tumour diameter: ≤40 mm (cT1a) and 41-70 mm (cT1b). The proportion of patients with benign RTB, complication rate and false negative RTBs was estimated from register data and previous research. A healthcare perspective was used and accounted for costs related to biopsy, surgery, follow-up of benign RTBs, complications and re-biopsy in cases of inconclusive RTBs.

Results: For cT1a, increasing preoperative RTBs to 90% of the study population reduced the net annual costs by €691,620, whilst for cT1b, costs increased by €67,630. Overall, an increase in preoperative RTBs to 90% of all patients with cT1 renal tumours was projected to reduce spending by €623,990 annually.

Conclusions: The budget impact analysis of routine preoperative RTBs in suspected renal cell carcinoma indicates net healthcare cost savings in cT1a and potentially for all cT1 tumours.

Objective: The current lack of standardised perioperative pain management protocols for open radical cystectomy (ORC) underscores the need for alternative approaches to the longstanding tradition of epidural block. The aim of this study was to assess the impact of bilateral single injection quadratum lumborum block (QLB) on patients' recovery and complication rates compared with epidural analgesia after ORC in a single-centre, randomised, parallel-group trial including adult patients with bladder cancer.

Material and methods: Consecutive ORC patients were randomly allocated into QLB and the epidural group. The primary endpoint of this study was related to opioid consumption, and the results have been published earlier. This report focuses on secondary outcomes.

Results: This study included a total of 41 patients, with 20 patients in the QLB group and 21 patients in the epidural group. Finally, 39 patients were included in the analysis.  There was a trend for more frequent need for postoperative norepinephrine and fluid support in the epidural group but without statistical significance. Postoperative complication rate was similar. Two patients in the epidural group compared to none in the QLB group were rehospitalised within 30 and 90 days. Mortality rate within 90 days was higher in the epidural group (4 vs. 0 patients, P = 0.064).

Conclusions: In this trial, there were no significant differences in surgical and oncological outcomes after ORC when QLB is compared with epidural block for postoperative analgesia.  Trial registration: ClinicalTrials.gov Identifier: NCT03328988.

Background: Swedish national guidelines provide evidence-based recommendations for standard of care; however, little is known about adherence to them. The aim of this study was to assess adherence to management guidelines for prostate cancer (PCa).

Materials and methods: Data in the National Prostate Cancer Register (NPCR), that includes 98% of all incident PCa cases in Sweden, were used to analyse adherence to national PCa guidelines for men diagnosed between 2010 and 2023. A selection of quality indicators displayed on the public web page of NPCR were assessed.

Results: Active surveillance in men with low-risk PCa and an estimated life expectancy >10 years increased from 44% in 2010 to 88% in 2023. Radical treatment for men with localised high-risk PCa and life expectancy >10 years increased from 60% in 2010 to 86% in 2023 and for men with locally advanced PCa and life expectancy >5 years from 37% in 2010 to 64% in 2023. The proportion of radical prostatectomies for low- or intermediate-risk PCa performed with nerve-sparing technique increased from 61% in 2015 to 87% in 2023. Use of adjuvant androgen deprivation therapy after radiotherapy for men with high-risk or locally advanced PCa increased five-fold from 14% in 2010 to 73% in 2022.

Conclusion: Adherence to recommendations in national guidelines improved in Sweden between 2010 and 2023. Public, open reporting of NPCR data on adherence to guidelines down to department level is likely to have contributed to these improvements.

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.