Lars Henningsohn

Vaginal Changes and Sexuality in Women with a History of Cervical Cancer

BACKGROUND In women with cervical cancer, treatment causes changes in vaginal anatomy and function. The effect of these changes on sexual function and the extent, if any, to which they distress women are not known. METHODS In 1996 and 1997, we attempted to contact 332 women with a history of early-stage cervical cancer (age range, 26 to 80 years) who had been treated in 1991 and 1992 at the seven departments of gynecological oncology in Sweden and 489 women without a history of cancer (controls) to ask them to answer an anonymous questionnaire about vaginal changes and sexual function. RESULTS We received completed questionnaires from 256 of the women with a history of cervical cancer and 350 of the controls. A total of 167 of 247 women with a history of cancer (68 percent) and 236 of 330 controls (72 percent) reported that they had regular vaginal intercourse. Twenty-six percent of the women who had cancer and 11 percent of the controls reported insufficient vaginal lubrication for sexual intercourse, 26 percent of the women who had cancer and 3 percent of the controls reported a short vagina, and 23 percent of the women who had cancer and 4 percent of the controls reported an insufficiently elastic vagina. Twenty-six percent of the women who had cancer reported moderate or much distress due to vaginal changes, as compared with 8 percent of the women in the control group. Dyspareunia was also more common among the women who had cervical cancer. The frequency of orgasms and orgasmic pleasure was similar in the two groups. Among the women who had cervical cancer, the type of treatment received had little if any effect on the prevalence of specific vaginal changes. CONCLUSIONS Women who have been treated for cervical cancer have persistent vaginal changes that compromise sexual activity and result in considerable distress.

Distressful Symptoms and Well-being After Radical Cystectomy and Orthotopic Bladder Substitution Compared With a Matched Control Population

Purpose: We compared subjective quality of life, well-being, urinary tract symptoms and distress in patients after radical cystectomy and orthotopic urinary reconstruction with those in a matched control population.Materials and Methods: Included in this study were 101 consecutive recurrence-free patients who underwent radical cystectomy and orthotopic bladder substitution with an ileal urethral Kock neobladder at Herlev Hospital with a minimum followup of 1 year. A frequency matched control group comprising 147 individuals was selected from the same geographical region. Information was collected by an anonymous postal questionnaire and analyzed externally in Sweden.Results: The prevalence of low or moderate psychological well-being (32% versus 36%) and subjective quality of life (30% versus 38%), and high or moderate anxiety (23% versus 18%) and depression (26% versus 37%) was similar in patients with an orthotopic neobladder and population controls. Patients with a neobladder felt as attractive as the c...

Patient-rating of distressful symptoms after treatment for early cervical cancer

Background. More refined information on sources of symptom‐induced distress in a patient population can improve the quality of pretreatment information, make follow‐up visits more efficient and guide research priorities in the efforts to modify treatments.

Distressful symptoms after radical radiotherapy for urinary bladder cancer.

BACKGROUND Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function. Here we studied symptoms, symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy. MATERIALS AND METHODS We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995. For comparison, 325 patients treated with radical cystectomy and urostomy, continent or non-continent, during the same period and 460 individuals randomly selected from the general population were included. Information was collected by means of an anonymously answered postal questionnaire to avoid investigator-related bias. RESULTS Answers were obtained from 58 (82%) radiated patients, 251 (85%) cystectomized patients and 310 (71%) population controls. Of the radiated patients, 74% reported little or no distress from symptoms from the urinary tract, 38% had had intercourse the previous month and 57% (men) reported they had ejaculated. Among the cystectomized patients, 13% had had intercourse and 0% (men) had ejaculated. Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32% of the radiated patients, 24% of the cystectomized patients and 9% of the population controls. After radical radiotherapy, 46% of the patients were willing to accept some risk of decreased survival to become symptom-free. CONCLUSIONS About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract. The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable.

Distressful Symptoms after Radical Cystectomy with Urinary Diversion for Urinary Bladder Cancer: A Swedish Population–Based Study

Objective: To study the excess prevalence of distressful symptoms after radical surgery for urinary bladder cancer. Methods: We included all patients who underwent cystectomy due to bladder cancer before 1996 in Stockholm County. A control group was randomly selected from the general population. Information was collected by means of an anonymous postal questionnaire. Results: Completed questionnaires were returned by 310 (71%) controls and 251 (85%) cystectomized individuals. A 5–fold (reservoir) and 9–fold (conduit) increase in defecation urgency and a 4–fold (reservoir) and 6–fold (conduit) increase in faecal leakage were reported in individuals operated on. Urinary tract infection was increased 3–fold in cystectomized individuals compared with controls, during the previous year 26% of the patients reported a symptomatic infection. The perception of a reduced physical attractiveness due to disease was more than 5–fold increased in the men operated on compared to the controls. The majority, 135 out of 201 (67%), reported that they would have refused alternative bladder–sparing procedures if they decreased the prospects of survival by even as little as 1%. Conclusions: The patient’s situation after cystectomy is considerably impaired due to changed bowel and sexual function, urinary tract infections and a sense of decreased attractiveness. However, most patients are in spite of this unwilling to compromise survival.

Self‐assessed health, sadness and happiness in relation to the total burden of symptoms from the lower urinary tract

To evaluate the effect of lower urinary tract symptoms (LUTS) on self‐assessed health, sadness and happiness of men.

Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire

Objective. To describe how different lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in men. Material and methods. The study included 1008 men aged 40–80 years living in the community of Surahammar, Sweden who had answered a questionnaire concerning stress incontinence, urgency and post-micturition dribbling 12 months earlier. The occurrence and severity/frequency of 12 specific LUTS were assessed using the Danish Prostatic Symptom Score questionnaire. QOL was evaluated using the Short Form 36 (SF-36) questionnaire. Results. Post-micturition dribbling was the most frequently reported symptom (71%) and stress incontinence the least common (11%). Men who experienced urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without such symptoms. Furthermore, men who experienced a moderate/severe degree of weak stream or nocturia reported a poorer QOL for all dimensions compared to men with a mild level of the same symptoms. QOL was found to decrease with increasing age. Men aged 66–80 years with “other incontinence” reported lower mean SF-36 scores for physical functioning, role physical, role emotional, social functioning and body pain than 40–65-year-old men. Conclusions. LUTS in men affect QOL dimensions differently. Storage symptoms appear to reduce QOL more than voiding and post-micturition symptoms. Urinary incontinence affected all eight of the dimensions evaluated. Elderly men with LUTS reported a lower QOL than younger men.

Relative importance of sources of symptom-induced distress in urinary bladder cancer survivors

OBJECTIVE The influence of specific symptoms on emotions and social activities in the individual patient varies. Little is known about this variation in urinary bladder cancer survivors (in other words, about the relative importance of sources of symptom-induced distress). METHODS We attempted to enroll 404 surgical patients treated with cystectomy and a conduit or reservoir in four Swedish towns (Stockholm, Orebro, Jönköping, Linköping), 101 surgical patients treated with cystectomy and orthotopic neobladder at the Herlev Hospital in Copenhagen, Denmark, and 71 patients treated with radical radiotherapy for bladder cancer, as well as 581 men and women controls in Stockholm and Copenhagen. An anonymous postal questionnaire was used to collect the information. RESULTS A total of 503 out of 576 (87%) treated patients and 422 out of 581 (73%) controls participated but 59 patients were excluded. The primary source of self-assessed distress among cystectomised patients was compromised sexual function; reduced intercourse frequency caused great distress in 19% of the conduit patients, 20% of the reservoir patients and 19% of the bladder substitute patients. The primary source of self-assessed distress in patients treated with radical radiotherapy was symptoms from the bowel; 17% reported great distress due to diarrhoea, 16% due to abdominal pain, 14% due to defecation urgency and 14% due to faecal leakage. The highest proportion of subjects being distressed was 93% (substantial: 43%, moderate: 29% and little: 21%) for treated upper or lower urinary retention (indwelling catheter or nephrostomy). CONCLUSION The distress caused by a specific symptom varies considerably and the prevalence of symptoms causing great distress differs between treatments in bladder cancer survivors. It is possible that patient care and clinical research can be made more effective by focusing on important sources of symptom-induced distress.

Time after surgery, symptoms and well-being in survivors of urinary bladder cancer

To evaluate how an increasing burden of symptoms influences well‐being, anxiety and depression at different intervals after a radical cystectomy with urostomy for bladder cancer, as this therapy can induce long‐term distressful symptoms.

Sleep Disturbances Decrease Self-Assessed Quality of Life in Individuals Who Have Undergone Cystectomy

PURPOSE The best possible urinary diversion after cystectomy, if any, is yet to be defined to our knowledge. Therefore, we investigated nocturnal urinary disturbances and quality of life in individuals who have undergone cystectomy with urinary diversion for bladder cancer. MATERIALS AND METHODS All patients 30 to 80 years old who had undergone cystectomy with urinary diversion at 7 urological centers in Sweden were included in the study. Sleep disturbances, nocturnal urinary leakage and urine evacuation frequency, as well as their effect on self-assessed quality of life variables were measured with a study specific questionnaire. We received the questionnaire from 452 (92%) of 491 identified individuals. Outcome variables were dichotomized and the results are presented as relative risks. RESULTS Those individuals with an orthotopic neobladder had an increased risk of nocturnal urinary leakage and/or urine evacuation frequency compared to those with a noncontinent urostomy or cutaneous continent reservoir. Of the patients with an orthotopic neobladder 37% reported negative effects on nocturnal sleep compared to 22% and 14% of those with a noncontinent or continent urostomy, respectively. Of those patients reporting that the urinary diversion had a negative effect on nocturnal sleep 88% had a decreased quality of life vs 65% of those who stated that the urinary diversion had no or little influence on nocturnal sleep. CONCLUSIONS Nocturnal urinary problems are of great concern for individuals with urinary diversion, especially those with an orthotopic neobladder. Regular disruption of sleep decreases quality of life.