Morten Jønler

Urinary Symptoms, Potency, and Quality of Life in Patients With Localized Prostate Cancer Followed Up With Deferred Treatment

OBJECTIVES To evaluate urinary symptoms, potency, and quality of life in a group of patients with prostate cancer followed up with deferred treatment. METHODS A self-administered questionnaire was mailed to patients with localized prostate cancer who were followed up with deferred treatment. Data regarding clinical stage, pathologic grade, and treatment after diagnosis were obtained from patient files. RESULTS A total of 71 consecutive patients (age 79 years or less) were included. Of the 52 patients (73%) who responded, 31% had undergone transurethral resection of the prostate, 8% underwent radiation therapy, and 44% underwent hormonal deprivation during the follow-up period. With respect to incontinence, 21% were using pads and 37% leaked urine daily; in 21% of the patients, urine dripping or leaking was a substantial problem. Before the diagnosis of their prostate cancer, 81% stated they were able to have an erection. At the time of the questionnaire, 77% stated that their ability to have erections was reduced and only 29% had had an erection after the prostate cancer was diagnosed. For 12%, impotence was a problem. With respect to quality of life, 52% of the patients rated their health as excellent or good and 61% would be happy to spend the rest of their life feeling the way they did at the time of the questionnaire. Eighty-five percent were satisfied with the treatment policy for their prostate cancer, and 96% would choose deferred treatment again if faced with the decision. CONCLUSIONS By use of a self-administered questionnaire, a high frequency of incontinence and impotence was found in a group of patients with prostate cancer followed up with deferred treatment. Despite these problems, more than half of the patients rated their health as good and would undergo expectant management again if faced with the decision.

Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia

To evaluate holmium:YAG laser vaporization of papillary tumours of the bladder, focusing on surgical technique, patients’ satisfaction, complications and cost‐effectiveness when using the technique under local anaesthesia as an outpatient procedure.

Peritoneal dialysis catheter placement: is laparoscopy an option?

Peritoneal dialysis (CAPD) is the preferred and gentlest type of dialysis in patients with end-stage renal disease (ESRD). One of the most frequent complications following peritoneal dialysis catheter (P-catheter) placement is malfunction owing to displacement, which frequently entails major problems for the patient, including reoperation and the risk of having to switch to haemodialysis. Consequently, to ensure optimal P-catheter function and reduce patient morbidity, it is essential to develop and assess new surgical techniques for dialysis catheter placement. The objective of this survey is to describe and assess a laparoscopic-assisted procedure for P-catheter placement.Material and methodsSurvey of laparoscopic-assisted P-catheter placements performed during a one-year period. The study describes the operative procedure, catheter function and complications. Furthermore, a comparison with open surgery performed in the period is made.ResultsOne of nine P-catheters inserted using laparoscopic-assisted surgery under general anaesthesia was displaced while four of 13 P-catheters inserted using traditional open surgery under local anaesthesia were displaced. The five displaced catheters were subsequently fixed laparoscopically under general anaesthesia.ConclusionLaparoscopic P-catheter placement is uncomplicated, quick and reduces P-catheter displacement frequency. Drawbacks include costly equipment and the need for general anaesthesia. Future follow-up will reveal whether laparoscopically placed P-catheters yield longer-lasting and better-functioning catheters than traditionally placed P-catheters.

Prostate-specific antigen testing in general practice : A survey among 325 general practitioners in Denmark

Objectives Prostate-specific antigen (PSA) is a well-known and -utilized tumor marker for prostate cancer. Elevated PSA values are not specific for prostate cancer as they may be caused by other benign conditions. PSA testing is widely used by urologists and non-urologists. Interpretation of test results is difficult but important. Referral of patients for further work-up on suspicion of prostate diseases is mainly done by general practitioners (GPs). As the GP remains the gatekeeper between the patient and the urologist in terms of diagnosing prostate diseases, basic knowledge of PSA testing is crucial. The purpose of this study was to evaluate the basic use and knowledge of PSA testing and to give an estimate of the need for further education in PSA testing amongst GPs in our area. Material and methods A questionnaire regarding PSA testing and associated needs for education was mailed to all GPs in the Northern County of Denmark. Non-respondents were contacted by mail. Results Of the contacted GPs, 90% responded. Only 28% of GPs measured PSA in all males complaining of lower urinary tract symptoms (LUTS). Of patients seen as part of a general health check-up, PSA testing was done in 10%. The median PSA value for referral to urologists for further work-up was 5 ng/ml, but the decision was influenced by PSA value (79%), age (65%) and findings on digital rectal examination (DRE) (87%). Opportunistic screening for prostate cancer was done by 14% of GPs. Of the GPs who responded, 24% stated that they did not need any further education regarding PSA testing. Conclusions The results of this study demonstrate that PSA testing is not standardized in our area. GPs do not test patients on the basis of recommendations provided by national or international societies. PSA testing is not used as a standard test in men with LUTS, and patients are not referred to urologists at a sufficiently low PSA level to improve the early diagnosis and work-up of patients with suspected prostate cancer. However, the decision of many GPs to refer patients to urologists for further work-up is influenced by the findings of a DRE, the age of the patient and the PSA value itself. Further education regarding PSA testing amongst GPs in our area would seem to be appropriate.

The Influence of a Urethral Catheter and age on Recorded Urinary Flow Rates in Healthy Women

Introducing a 7 F catheter into the urethra reduced the maximum and average flow rate and increased the micturition time significantly in healthy fertile and postmenopausal women. The menstrual cycle had no influence on the parameters. Urinary flow data were highly reproducible in both the fertile and the postmenopausal women. The flow rate-volume relation can be mathematically expressed, allowing for corrections when small voided volumes or small flow rates are obtained. Furthermore, this relation showed an increased flow time and a decreased flow rate in the postmenopausal women. This might indicate that the postmenopausal women had a reduced bladder contractility or a less compliant urethra.

Quality of life in patients with skeletal metastases of prostate cancer and status prior to start of endocrine therapy: Results from the scandinavian prostate cancer group study 5

Objectives Prostate cancer (PC) is a highly lethal neoplastic disease affecting the physical, mental and social well-being of patients, i.e. their quality of life (QOL). Patients suffering from metastatic PC are faced with serious decisions regarding treatment strategies. Therefore, QOL information has become a crucial element of decision making in this group of patients. The first objective of this study was to describe QOL in a group of patients diagnosed with metastatic PC and skeletal metastases. At the time of evaluation the patients had not received any treatment but were evaluated before entering a study of androgen-modulating therapy (the Scandinavian Prostate Cancer Group study 5). The second objective was to identify demographic and disease-related factors affecting QOL. Material and methods A total of 917 patients with metastatic PC were evaluated using a well-described and validated questionnaire [European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (EORTC QLQ-C30)]. The characteristics of the PC were noted, and simultaneously patients were evaluated with respect to use of analgesics, pain and performance status using a scoring system. Biochemical tests were performed when patients entered the study. A multivariate regression analysis was performed to analyse the correlations between QOL scores, patient demographics and disease-related data. Results The patients reported QOL scores significantly lower than those in the background population. Pain and fatigue were pronounced, whereas dyspnoea, insomnia, loss of appetite, constipation and diarrhoea were less prominent. Patients with high tumour grades, high PSPA scores (the sum of the pain score, the performance status and the use of analgesics) and those using analgesics had significantly lower QOL scores than the other patients. Conclusions Patients with metastatic PC have reduced QOL. Our findings are in line with those of other studies of QOL among patients with this disease as evaluated by means of the EORTC QLQ-C30 questionnaire. Baseline data from studies like this provide important information when treatment modalities for PC are evaluated.

Bisphosphonate (zoledronic acid)-induced osteonecrosis of the jaw

Abstract Objective. The use of bisphosphonates (zoledronic acid) in the treatment of metastatic bone disease has been raised during recent years. The purpose of this treatment is mainly to reduce skeletal-related events, e.g. pain and pathological fractures. The aim of this study was to report the incidence of bisphosphonate-related osteonecrosis of the jaw (ONJ). Material and methods. All patients treated with bisphosphonates during a 5-year period (2003–2007) were reviewed. Results. Fifty-three patients, median age 69 years (range 56–81 years) were treated with bisphosphonates during the period. Fifty-one patients had hormone-refractory metastatic prostate cancer and two women had metastatic renal cell carcinoma. During this 5-year period, 686 treatments with bisphosphonates were administrated. The average treatment duration was 14 months (range 1–40 months) with administration of 4 mg of bisphosphonates every 4 weeks. Two cases of ONJ were registered. In the first case, the patient developed spontaneous osteonecrosis, whereas the second patient developed symptoms after a dental procedure. Since the initiation of a routine maxillofacial examination before treatment with bisphosphonates, no ONJ has been seen. Conclusion. ONJ is a rare but a very serious complication in relation to treatment with bisphosphonates. To decrease the incidence of ONJ, a maxillofacial examination could be performed in all patients before treatment with bisphosphonates.

Recurrent urinary tract infection due to hernia mesh erosion into the bladder

We present a rare cause of recurrent urinary tract infection and calculus formation: erosion of a mesh after an inguinal repair into the bladder of a 77-year-old male.

Prostate cancer after exogenous testosterone replacement therapy in a patient with pituitary insufficiency

We present the case of a patient who was diagnosed with prostate cancer after 15 years of exogenous testosterone therapy. We discuss the literature on testosterone treatment, its possible prostatic complications and guidelines for monitoring the prostate during treatment.

Laparoscopic correction and fixation of displaced peritoneal dialysis catheters.

Displacement or omental wrapping of an abdominal peritoneal dialysis catheter often results in malfunction. Attempts to move the omental flap or replace the catheter in the pelvic cavity utilizing different types of guide wires is often difficult, time consuming and has the potential of adding damage to abdominal organs [1]. Moreover, the catheter might be displaced or wrapped again resulting in a repeated malfunction. Clearly correct positioning of dialysis catheters saves the patients from further surgery and potential risks and saves society for additional costs. We describe a laparoscopic approach to correct and secure a displaced abdominal peritoneal dialysis catheter. The procedure is fast and easy to perform, is safe, has no learning curve and requires only standard laparoscopic equipment and is found to have both good short and long-term results.