Håkan Lindkvist

How do urinary incontinence and urgency affect women's sexual life?

Objective. To investigate the impact of urinary incontinence and urgency on womens sexual life and the prevalence of urinary leakage during sexual activity. A further aim was to explore factors affecting sexual desire and satisfaction with sexual life. Design. A semi‐structured questionnaire study. Setting and Sample. Sexually active women (n=147) aged 18–74years with urinary incontinence and urgency were recruited from four outpatient clinics. Methods. The women completed questionnaires concerning medical history, psychosocial situation, partner relationship and sexual life, and answered the Bristol Female Lower Urinary Tract Symptoms questionnaire. All underwent clinical evaluation. Main Outcome Measures. Prevalence of urinary leakage during sexual activity, factors affecting sexual desire and sexual satisfaction. Results. The vast majority considered sexuality to be important in their lives. One‐third of the women had urinary leakage during sexual activity. Half reported that sexual life was more or less spoiled due to their urinary incontinence or urgency and they were worried about having urinary leakage during intercourse, and almost two‐thirds worried about odor and felt unattractive. The womens dissatisfaction with sexual life was strongly correlated to unsatisfying psychological health, orgasmic disability and worry about urinary leakage during intercourse. Insufficient vaginal lubrication, unsatisfying psychological health and their partners’ ill health were significantly correlated with decreased sexual desire. Conclusions. Urinary incontinence and urgency have a negative impact on womens sexual life. Thus, a dialogue about sexual function in women with urinary symptoms should become an integral component in clinical management.

Influence of the modifiable life‐style factors body mass index and smoking on the outcome of hysterectomy

The aim of this study was to study the impact of body mass index (BMI) and smoking on the outcome of hysterectomy and whether effects of these factors vary between abdominal, laparoscopic and vaginal hysterectomy.

A class of non-parametric tests in the competing risks model for comparing two samples

We consider a model when a process involving the production of elements is under inspection. The elements have possible failures due to competing risks. We assume the availability of a data set of failure times, D1, obtained when the process is under control. Our main goal is to test if the failure rates in D1 are equal to or less than the failure rates in another data set D2, against “undesirable” neighbouring alternatives. A class of tests based on a two-dimensional vector statistic is obtained. Linear test statistics with weight functions giving optimal local asymptotic power are derived. Martingale techniques are used. An example illustrates the derivation of reasonable tests

A Swedish population-based evaluation of benign hysterectomy, comparing minimally invasive and abdominal surgery

OBJECTIVE The aim was to evaluate surgical routes for benign hysterectomy in a Swedish population, including abdominal and minimally invasive surgery. STUDY DESIGN Prospectively collected data from the Swedish National GynOp Registry 2009-2015: 13 806 hysterectomy cases were included: abdominal (AH, n = 7485), vaginal (VH, n = 3767), conventional laparoscopic (LH, n = 1539) and robotically-assisted (RAH, n = 1015). RESULTS The VH group had the shortest operation time at 75 min, AH 97 min and RAH 104 min. LH was longest at 127 min (p < 0.005). The mean estimated blood loss was higher in the AH group (250 ml) compared to all minimally invasive surgery (MIS, 65-172 ml); p < 0.005). Conversion rates were 10% for LH, 4.8% for VH and 1.6% for RAH (p < 0.005). Hospitalization and patient-reported time to normal activities of daily living (ADL) were longer for AH compared to MIS (p < 0.005). Time to return to work was eight days longer in the AH group (35 days) compared with the MIS groups (p < 0.005). Complications were fewest in the VH group at 5.4% compared with AH 7.6% and RAH 8.7% (both p < 0.001), but did not significantly differ from the LH group at 6.6%. Overall patient satisfaction was reported to be 86-94% one year after surgery. CONCLUSION Women operated on for benign hysterectomy with minimally invasive methods in Sweden 2009-2015 had reduced length of hospitalization, as well as time to resuming normal ADL and return to work, compared to AH. Postoperative outcome measures were improved by minimally invasive methods and MIS should preferably be used.

Asymptotic Properties of Estimators in a Model of Life Data with Warnings

Abstract We consider a model where elements of a single type are life tested. All elements are observed up to the time of their failures or censorings. Three types of events are possible to observe during life testing for each element: failure, censoring, and warning, where a warning can only be observed before a failure or before censoring has occurred. It is essential to know if warnings influence subsequent failures. Two subsets of data are simultaneously considered: the first consisting of only the times of the first occurrences of failure, censoring, or warning, and the second consisting of the times for those elements where warnings occurred before failures or censorings. The first subset belongs to the competing risks model, and the second consists of left-truncated data. Estimators of the cumulative hazard function before and after warnings are derived and proved to be consistent, with asymptotic normal distributions. A null hypothesis where the cumulative hazard functions before and after warnings are proportional and a corresponding alternative hypothesis that they are not proportional are defined. Under this null hypothesis an estimator for the constant of proportionality is derived and showed to be strongly consistent. Martingale techniques are used and numerical examples are provided.