Scandinavian Journal of Urology最新文献

Objective: To analyze the factors and costs associated with 30-day readmissions for patients undergoing radical nephrectomy.

Materials and methods: We used the 2014 Nationwide Readmission Database to identify adults who underwent radical nephrectomy for renal cancer, stratified by surgical approach. We determined patient factors associated with readmission rates, diagnoses, and costs using multivariate logistic regression.

Results: Among 19,523 individuals, the 30-day readmission rate was 7.7% (n = 1,506). On multivariate regression, odds of readmission were significantly increased with age ≥75 in those who underwent open nephrectomy (OR: 1.35; 95%CI: 1.03-1.78). Subjects with a Charlson comorbidity score ≥3 had significantly higher rates of readmission regardless of surgical approach (Open RN - OR: 1.85; 95%CI: 1.33-2.56; Lap RN - OR: 1.99; 95%CI 1.10-3.59; Robotic RN - OR: 2.18; 95%CI: 1.23-3.86). Common reasons for readmission were gastrointestinal, cardiovascular, urinary tract infections, and wound complications across all surgical approaches. The mean cost per readmission was as high as 126% ($20,357) of the mean index admission cost.

Conclusion: One in 13 adults undergoing radical nephrectomy is readmitted within 30 days of discharge. Associated readmission cost is up to 1.26 times the cost of index admission. Our findings may inform efforts aiming to reduce hospital readmissions and curtail healthcare costs.

Objective: To evaluate the effect of pre-biopsy povidone-iodine rectal cleansing on post-biopsy hospitalization rates due to prostate biopsy-related infectious complications.

Material and methods: In this retrospective study, we reviewed 552 patients who underwent ultrasonography-guided transrectal prostate biopsy between 2014 and 2022. Group 1, 361 patients (January 2014-October 2020) were not applied povidone-iodine rectal cleansing, and group 2, 191 patients (November 2020-January 2022) were applied povidone-iodine rectal cleansing since we changed our biopsy protocol. All patients were given the same antibiotic prophylaxis, ciprofloxacin 500 mg, and ornidazole 500 mg twice daily starting 24 h before the biopsy and lasting a total of 5 days. Sodium phosphate enema was applied to all patients in the biopsy morning. The outcome was the hospitalization rates of patients because of infectious complications a month after the biopsy.

Results: No patients were hospitalized in the povidone-iodine rectal cleansing group because of biopsy related complications. The hospitalization rate of group 1 was 3% and there was a statistical difference between groups.

Conclusion: The povidone-iodine solution is cheap, safe and easy to apply. The povidone-iodine rectal cleansing method seems to decrease infectious complications related to prostate biopsy procedure, but we need a randomized controlled trial to confirm our study.

Trial registration: We got permission for this retrospective study from the Karabuk university ethics council with the number 2021/649 on 1 October 2021.

Aim: This study aims to evaluate the safety and efficacy of salvage HDR brachytherapy in patients who have undergone a thorough diagnostic process.

Materials and methods: 100 prostate cancer patients - locally relapsed after previous radiotherapy - were treated with salvage HDR brachytherapy to a total dose of 24 Gy. Before treatment, the patients underwent PET imaging, prostate MRI, and prostate biopsies to confirm local relapse and exclude systemic disease. Concomitant ADT was applied in 69 patients. Toxicity and efficacy data were collected as a patient chart review. Toxicity was graded using Common Terminology Criteria for Adverse Events (CTCAE 5.0).

Results: The 3-year bDFS and OS were 74% (confidence interval [CI] 95%: 60-87%) and 93% (CI 95%: 84-100%), respectively. Acute Grade 1-2 genitourinary toxicity was observed in 70 patients, 58 patients with Grade 1 and 12 patients with Grade 2, respectively. Acute Grade 1 gastrointestinal toxicity was observed in 8 patients.

Conclusions: This retrospective study shows that salvage HDR brachytherapy is a well-tolerated and effective treatment for histologically proven, local radio-recurrent disease.

Background: Erectile dysfunction (ED) is common after radical prostatectomy (RP) due to cavernous nerve damage. Risk of ED is also affected by vascular function. Statins prevent vascular events but their association with post-prostatectomy ED is unclear. We explored the likelihood of starting ED treatment after RP by statin use at the population level.

Methods: The study cohort included 14,295 prostate cancer (PCa) patients with no ED treatment prior to diagnosis of PCa treated with RP in Finland during 1995-2013. Information on use of cholesterol-lowering drugs and ED medication during 1995-2014 and penile prosthesis implantation during 1996-2014 were gathered from national registries. Risk of ED treatment initiation after RP was analyzed by pre-diagnostic and post-diagnostic statin and non-statin cholesterol lowering (NSCL) drug use with Cox regression model.

Results: Pre-diagnostic statin use or NSCL drug use overall had no association with risk of ED treatment initiation after RP. Post-diagnostic statin use was associated with a slightly increased risk of initiation of any ED treatment (HR = 1.07; 95% CI = 1.01-1.14). Patients with the longest duration of post-diagnostic statin use had a significantly decreased risk of PDE5 inhibitor initiation compared to non-users (HR = 0.43; 95% CI = 0.20-0.94). Among patients with no cardiovascular comorbidities, pre-diagnostic statin users had a significantly increased risk of initiation of injectable ED drugs (HR = 1.27; 95% CI = 1.04-1.55), however, no association with risk of any other ED treatment was observed.

Conclusion: Statin users have a slightly increased risk of ED treatment initiation after RP, which probably reflects the effect of the underlying vascular insufficiency.

Objective: Patients with clinical T1 renal cell carcinoma (cT1RCC) have risks for recurrence and reduced overall survival despite being in the best prognostic group. This study aimed to evaluate the association of different treatments on disease recurrence and overall survival using clinical and pathological characteristics in a nation-wide cT1RCC cohort.

Materials and methods: A total of 4,965 patients, registered in the National Swedish Kidney Cancer Register (NSKCR) between 2005 and 2014, with ≥ 5-years follow-up were identified: 3,040 males and 1,925 females, mean age 65 years. Times to recurrence and overall survival were analyzed with Kaplan-Meier curves, log-rank test, and Cox regression models.

Results: Age, TNM-stage, tumor size, RCC-type, and performed treatment were all associated with disease recurrence. Patients selected for ablative treatments had increased risk for recurrent disease: hazard ratio (HR) = 3.79 [95% confidence interval (CI) = 2.69-5.32]. In multivariate analyses, age, gender, tumor size, RCC-type, N-stage, recurrence and performed treatment were all independently associated with overall survival. Patients with chRCC had a 41% better overall survival (HR = 0.59, 95% CI = 0.44-0.78; p < 0.001) than ccRCC. Patients treated with partial nephrectomy (PN) had an 18% better overall survival (HR = 0.83, 95% CI = 0.71-0.95, p < 0.001) than patients treated with radical nephrectomy.

Conclusions: Age, gender, T-stage, tumor size, RCC type and treatment modality are all associated with risk of recurrence. Furthermore, age, male gender, tumor size, N-stage and recurrence are associated with reduced overall survival. Patients with chRCC, compared with ccRCC and pRCC patients, and PN compared with RN treated patients, had an advantageous overall survival, indicating a possible survival advantage of nephron sparing treatment.

Introduction: Prognostic models of survival can identify patients with extrinsic malignant ureteral obstruction who will benefit from long-term drainage as offered by tandem ureteral stents. The study aims to validate a simplified prognostic model published by Cordeiro et al. and to identify additional prognostic predictors in a cohort of patients drained solely with tandem ureteral stents.

Methods: Medical records of consecutive patients who underwent drainage of malignant ureteral obstruction with tandem ureteral stents between 2007 and 2020 were reviewed retrospectively; patients with benign ureteral obstruction were excluded. Risk factors for survival included were: [1] the number of malignancy-related events (categorized as ≥4 and <4) and [2] the Eastern Cooperative Oncology Group Index (categorized as ≥2 and <2)]. Patients with ≥1 risk factor were grouped as intermediate-unfavorable risk and those without risk factors as favorable risk. The Kaplan-Meier and log-rank tests were used for survival analysis. Univariable and multivariable Cox regression analyses were used to identify predictors of outcome.

Results: The study cohort consisted of 65 patients; the median age was 60 years (IQR 51-72). The median follow-up time from diagnosis of hydronephrosis was 51 months (IQR 38-64). Estimated probabilities of survival at 1 month, 6 months 1 year, and 2 years were 100%, 87%, 75% and 57%, respectively in the favorable risk group (n = 40), and in the intermediate-unfavorable risk group (n = 25), 96%, 72%, 52%, and 20%, respectively, (p = .003). On multivariable analysis, the presence of ≥4 malignancy-related events (HR = 2.04, 95% CI [1.07-3.86], p = .03) and lung metastasis (HR = 2.37, 95% CI [1.0-5.6], p = .05) were associated with shorter survival.

Conclusions: Our findings validate the prognostic model published by Cordeiro et al. The model can be applied when counseling patients being considered for drainage with tandem ureteral stents.

Objective: The incidence of bladder cancer is three times as high in men compared to women. Moreover, women are generally diagnosed with a more severe tumor stage and have poorer prognosis. This study aimed to examine the association between gender, stage, and prognosis among a subgroup of bladder cancer patients treated with radical cystectomy.

Patients and methods: A total of 460 patients (131 women, 329 men) with bladder cancer undergoing radical cystectomy at Aarhus University Hospital in 2015-2018 were retrospectively selected for this study and followed until 2021 at the latest. Correlations between gender, patient and tumor characteristics and oncological outcomes were analyzed by the Chi-squared test. By the use of multiple linear regression, we adjusted for age, comorbidity and the proportion of organ-confined and non-organ-confined disease at diagnosis.

Results: Female patients were found to be younger and less comorbid than male patients. A higher proportion of patients with muscle-invasive bladder cancer and non-organ-confined disease at the time of cystectomy was observed among female patients. Recurrence of cancer occurred 3.4 (0.1-6.7) months earlier in female patients, and they had a 47% higher cancer-specific mortality (RR = 1.47 (1.04-2.1)) compared to male patients. In the adjusted analysis, the association of an earlier recurrence in female patients remained.

Conclusion: This study verifies that gender disparities exist among bladder cancer patients, even after adjusting for age, comorbidity and for the proportion of organ-confined and non-organ-confined disease at cystectomy. Further investigations are required to investigate the etiology of this observed difference between sexes.

Purpose: To understand the potential impact of new treatment options for urinary tract cancer, recent population trends in incidence, mortality and survival should be elucidated. This study estimated changes in the incidence, mortality and relative survival of urinary tract cancer in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) between 1990 and 2019.

Methods: Annual counts of incident cases and deaths due to urinary tract cancer (International Classification of Diseases, Tenth Revision, Clinical Modification codes C65-C68, D09.0-D09.1, D30.1-D30.9 and D41.1-D41.9) in Nordic countries were retrieved in 5-year age categories by sex during the study period. Country-specific time trends (annual rate ratios [RRs]) were estimated using Poisson regression, and RRs were compared between sexes.

Results: The incidence rate of bladder and upper urothelial tract cancer was >3-times lower in women than men in all countries across all age groups (incidence RR for women to men ranging from 0.219 [95% CI = 0.213-0.224] in Finland to 0.291 [95% CI = 0.286-0.296] in Denmark). Incidence rates were lowest in Finland and highest in Norway and Denmark. Age-adjusted mortality decreased in Finland, Denmark and Norway and in Swedish men, with the greatest decrease seen in Danish men (annual RR = 0.976; 95% CI = 0.975-0.978). In all countries and age groups, women had a lower relative survival rate than men.

Conclusion: Between 1990 and 2019, the incidence of urinary tract cancer was stable in the Nordic countries, while mortality rates declined and relative survival increased. This could be due to earlier diagnosis and better treatment.