Åsa Månsson

The quality of life in men after radical cystectomy with a continent cutaneous diversion or orthotopic bladder substitution: is there a difference?

Objective  To compare the quality of life (QoL) in men after radical cystectomy who had either a continent cutaneous diversion or orthotopic bladder substitution.

Continent urinary tract reconstruction – the Lund experience

The Department of Urology in Lund, Sweden, has a long association with innovations in reconstructive urology. The authors from that department describe their experience over a long period with orthotopic bladder substitution and continent cutaneous urinary diversion. They conclude that continent urinary tract reconstruction is associated with a high incidence of early and late complications. They also found that for storage and emptying, their Lundiana pouch was superior to the Goldwasser neobladder.

When the bladder is gone : quality of life following different types of urinary diversion

Abstract Methods aiming for continence after radical cystectomy for bladder cancer, e.g., continent cutaneous urinary diversion and orthotopic bladder substitution, have become clinically accepted alternatives to ileal conduit diversion in the past decade. The a priori assumption has been that improvement in the postoperative quality of life would be greater following the new methods than after ileal conduit diversion. Studies on the validity of this assumption have been hampered by a lack of consensus on what should be measured and how this should be done: in no two studies have identical test instruments been used. The frequent inclusion of patients with nonmalignant disease has also impeded comparative evaluation of reports. By and large, published studies do not seem to confirm that the new types of urinary tract reconstruction improve the quality of life of bladder cancer patients. Common for all methods are psychosocial and sexual problems.

Impact of extended written information on patient anxiety and image motion artifacts during magnetic resonance imaging

Purpose: To evaluate whether increased written information to patients prior to magnetic resonance imaging (MRI) decreases patient anxiety and image motion artifacts. Material and Methods: A two-group controlled experimental design was used. Of 242 patients, 118 received routinely given basic written information (control group) while 124 were given increased written information (intervention group). To measure patient anxiety before and during scanning, the self-report psychometric test State-Trait Anxiety Inventory (STAI) was used. After MR examination, the patients answered a questionnaire on satisfaction with the written information. The images were assessed with regard to motion artifacts. Results: Motion artifacts were present in fewer patient images in the intervention group than in the control group (4.0% versus 15.4%; P = 0.003). There was no significant difference between the control and the intervention group regarding patient anxiety and satisfaction with the information. Women in both groups showed a higher level of anxiety than the men did. Conclusion: Increased information about the MRI scanning procedure and expected experiences during the scan may help patients to lie still during the sequences, with a decrease in motion artifacts. However, further research is needed to evaluate the effect of other interventions on patient anxiety during MRI scanning.

Diagnostic delay and prognosis in invasive bladder cancer

Objectives: To study diagnostic delay in invasive bladder cancer in a population‐based material with long‐term follow‐up, and to evaluate whether delay in diagnosis affects the risk of bladder cancer death. Material and Methods: In a previous study, 177 patients with invasive bladder cancer (T1–T4) diagnosed in 1988 were investigated with regard to diagnostic delay. A review of all available clinical records was performed. In the present study, causes of death for these patients were registered over a 12‐year follow‐up period, and the impact of diagnostic delay on bladder cancer death was studied by means of survival analysis. Results: The median diagnostic delay in the material was 144 days. When the patients were stratified into groups with diagnostic delays of 0–3, 3–6, 6–12 and >12 months, those with T1 tumours in the two groups with a diagnostic delay of <6 months showed a trend towards a decreased risk of bladder cancer death. In contrast, in patients with muscle‐invasive disease, a significantly increased risk of bladder cancer death was noted for those with a diagnostic delay of <6 months. Conclusion: A trend towards better prognosis was found for patients with T1 tumours with a shorter diagnostic delay. The poor prognosis of patients with muscle‐invasive disease and a short diagnostic delay suggests aggressive behaviour of the tumour and may explain the worse prognosis in these patients.

Children having magnetic resonance imaging: A preparatory storybook and audio/visual media are preferable to anesthesia or deep sedation.

As a magnetic resonance imaging (MRI) examination lasts about 45 minutes and as the technique is sensitive to motion, children are often given sedation or anesthesia. The aim of this study was to examine whether children aged three to nine years could undergo MRI while awake and achieve adequate image quality if age-adjusted routines were used. A two-group controlled experimental design was used. Thirty-six children were assigned to a control group and underwent MRI with the prevalent routines. Thirty-three children were assigned to an intervention group and underwent the MRI while awake. The age-adjusted routine included a booklet and a story book, a model of the MRI scanner with the MRI sound, and a DVD film during the examination. In the control group, 30 children underwent the examination under anesthesia and 6 underwent the examination while they were awake. All had acceptable examinations. In the intervention group, 33 children had their examination while awake and 30 of them had acceptable examinations. The parents’ satisfaction with the care was assessed to be equal or higher in the intervention group and the costs were calculated to be lower. Thus, many children receiving age-appropriate preparation and distraction can undergo MRI examinations while awake.

Urinary diversion and bladder substitution in patients with bladder cancer.

For the majority of patients with invasive bladder carcinoma, radical cystectomy remains the gold standard of care. As a result the twentieth century has seen the continuous development of methods for reconstructing the urinary tract. Two decades ago the ileal conduit was by far the most commonly used method, whereas today methods geared toward patient continence are first choices in most centers. Some of these methods are unquestionably more complex than the ileal conduit, yet whether they actually yield uniformly improved quality of life is the cause of much debate. Many different variables play a role in determining the best type of reconstruction for an individual bladder cancer patient. This review analyzes the different factors that must be considered to obtain an optimal match between patient and reconstructive method.

Reply to “data analysis in radiology research”

Sir, We fully agree with the comments made by Dr. Vehmas, that multivariate analyses are preferable when studying phenomena such as motion artifacts during MRI. However, in this case, we made the judgment that multivariate analysis was not applicable. The reason was that the number of artifacts, especially in the intervention group, was considered to be too small to give sustainable results. We did, however, perform a multivariate logistic regression (backward, LR) with the variables suggested by Dr. Vehmas. This resulted in the risk for motion artifacts being lower in the intervention group (OR 0.202; 95% CI 0.071–0.572, P50.003). In addition to this, intravenous contrast injection was significantly associated with motion artifacts (OR 0.320; 95% CI 0.103–0.998, P50.05). This finding, however, being close to non-significant, is equivocal and difficult to interpret in a meaningful manner.

Lower urinary tract reconstruction

During the past century a fascinating development in procedures for lower urinary tract reconstruction has taken place. Within few fields of surgery has greater ingenuity been exercised than in the methods devised for diversion of urine. Since the first report on such a procedure 150 years ago, the urine stream has been conveyed to the outside of the body with the use of an infinite number of surgical techniques.1 The practicability of the described techniques has often not corresponded to their theoretic advantages, and only a few have been accepted for clinical use. Today the most commonly used methods are conduit diversion, continent cutaneous diversion and orthotopic bladder replacement. For these methods there are now long-term results available with regard to functional outcome, i.e. flow, storage and emptying of urine. Renal function and metabolic consequences of incorporating bowel segments into the urinary tract have been clarified and the impact on patients’ quality of life studied. During the past 10 years, development has concentrated on refining these methods.