Peder H. Graversen

Intracavernous self-injection for impotence: a long-term therapeutic option? experience in 78 patients

A total of 78 patients 17 to 84 years old reported their experience via questionnaire with the papaverine-phentolamine injection technique for impotence. The mean number of injections used was 30.7. Penile induration occurred in 13 patients (16 per cent) and it was generally of limited extent. A higher incidence of induration was observed in those with vasculogenic impotence. Prolonged erection was reported by 23 per cent of the patients, 8 per cent of whom experienced erection for more than 12 hours. Priapism occurred exclusively in diabetic patients and patients with a neurological etiology of impotence. A total of 22 per cent of the patients reported moderate to severe pain with injection, 35 per cent indicated decreased quality of erection with time in response to the vasoactive agents and 28 per cent believed this therapy to be unsatisfactory. Among those who discontinued the injections 5 cited variability of erectile response (duration or quality) as the reason for discontinuation. A decrease in the effectiveness of the injections with time may be anticipated among some patients. For patients who face a penile implant without other options penile self-injection with vasoactive drugs is a reasonable alternative in that complications do not prevent successful prosthetic implantation.

Bladder neck suspension material investigated in a rabbit model.

Different principles for providing stable and durable suspension of the bladder neck and proximal urethral tissue are employed in endoscopic bladder neck suspension for female stress urinary incontinence. Six different anchor materials, some of which are currently used as tissue bolsters (anchors) for endoscopic bladder neck suspension, were implanted in the abdominal wall muscle of 45 rabbits. Tension on the anchors was measured and maintained by springs positioned between pairs of anchors. At two months evaluation, vascular graft and loops of suture retained 40% of the starting tension, while two sizes of screw anchors lost all tension. Silicone pads and kink free silicone tubing rapidly pulled through the tissue in 83% and 100% of the cases, respectively. Local tissue reaction with scar formation, physical characteristics of the anchor material (silicone, stainless steel, dacron or polypropolene) and cross sectional area of the anchor were identified as the important factors for anchor stabilization of tissue which has been repositioned under tension.

Quinolone penetration into canine vaginal and urethral secretions.

Four newer quinolones (amifloxacin, ciprofloxacin, enoxacin, norfloxacin) were administered to female dogs by intravenous infusion. Drug concentrations in plasma, urine, and vaginal and urethral secretion were determined by bioassay. All four quinolones penetrated into vaginal and urethral secretion in concentrations several times higher than the MIC against common urinary pathogens, ciprofloxacin and norfloxacin reaching concentrations exceeding the simultaneous plasma concentrations. Because of their favorable antibacterial spectra, new quinolones should be investigated clinically for the treatment of recurrent urinary tract infection and bacterial vaginitis.

Improved survival of patients with prostate cancer in northern Denmark, 1985-2004.

Objective. In 2003 prostate cancer was the commonest non-cutaneous cancer among men. In general, the prognosis for men with prostate cancer is less favourable in Denmark than in neighbouring countries. We aimed to examine possible changes in the long-term survival of patients with prostate cancer in four counties in Denmark during the period 1985–2004. Material and methods. From four Danish counties (population 1.6 million) we included all patients (n=8928) with an incident discharge diagnosis of prostate cancer, as recorded in regional hospital discharge registries. We determined age-stratified survival and mortality rates, and used Cox proportional hazards regression to assess changes over time while controlling for age. Results. The median age was 75 years (range 43–99 years). The number of patients increased during the four time periods, especially for those aged <70 years. The overall survival rate improved over time, in particular for the period 2001–04. One-year survival increased from 71% (1985–89) to 77% (2001–04). Overall 5-year survival was unchanged (26% and 28% for 1985–89 and 2001–04, respectively), whereas 5-year survival in patients aged <70 years improved from 35% in 1985–89 to 41% in 1995–99. Compared with the period 1985–89, the age-adjusted 1-year mortality rate ratio (MRR) was 0.79 (95% CI 0.70–0.89) (2000–04) and the age-adjusted 5-year MRR was 0.95 (95% CI 0.88–1.02 (1995–99). Conclusions. The survival of prostate cancer patients has improved in Denmark over the time period 1985–2005, and this change was most pronounced in men aged <70 years. These results may suggest a benefit from increasing use of prostate-specific antigen testing leading to an earlier diagnosis of prostate cancer, in some cases with a lower tumour burden.

Shared care in prostate cancer: a three-year follow-up

Abstract Objective: The aim of this study was to investigate 3 year follow-up in patients with stable prostate cancer (PCa) managed in a shared care program by general practitioners (GPs) in collaboration with urological departments. PCa patients who have undergone curative treatment or endocrine therapy require long-term follow-up. Until recently, follow-up has primarily been managed by urologists at hospital-based outpatient clinics. However, new organizational strategies are needed to meet the needs of the growing number of elderly, comorbid cancer patients. These new organizational strategies target patients, GPs and specialists as joint stakeholders in the care and management of PCa. Materials and methods: In this 3 year follow-up to a Danish shared care PCa trial, 530 patients, out of a total of 2585 patients, were outsourced to the GPs. Strict evaluation criteria were selected to assess compliance according to individually agreed follow-up and re-referral plans for patients and GPs, respectively. Results: This study included 426 (80.4%) out of the 530 PCa patients. Among these, 196 patients had initially undergone curative-intended treatment, whereas 230 patients underwent non-curative treatment. Ninety-one deaths occurred during the study period. Among the 425 patients who were alive, 335 (78.8%) gave consent for their medical records to be accessed. Overall, patient compliance was successfully met in 390 (91.5%) of the cases, while GP compliance was successfully met in 393 (92.3%) of the cases. Conclusion: The shared care regimen for patient follow-up between the departments of urology and the local GPs had a high rate of patient and GP compliance.

Laparoscopic pelvic lymph-node dissection in prostate cancer before external beam radiotherapy: Risk factors of nodal involvement and relapse following intended curative treatment

Objective. To report experience with laparoscopic pelvic lymph-node dissection (LPLND) in patients with prostate cancer before radiotherapy. Selection of risk factors for nodal involvement (N1) and recurrence following radiotherapy was made. Material and methods. From November 1999 to June 2007, 177 patients with prostate cancer underwent LPLND at this department. The lymphadenectomy was limited to the obturator fossa bilaterally. Patients without nodal involvement were offered external beam radiotherapy with adjuvant hormone treatment. Results. Complications occurred in 17 patients (9%). The majority of these were minor and were managed by conservative methods. Twenty-six patients (15%) were diagnosed with N1. High Gleason score and a high percentage of positive needle core biopsies were both risk factors of N1 as well as recurrent disease following radiotherapy (p<0.01 and 0.01, respectively). Clinically, T3 disease was associated with a risk of recurrence but not N1. High prostate-specific antigen (PSA) nadir was also a significant predictor of recurrence. Neither pretreatment PSA nor prostate volume was associated with N1 or recurrence. Conclusions. LPLND is a safe, well-established staging modality in clinically localized prostate cancer before radiotherapy. Risk factors upon diagnosis may be useful in the estimation of N1 and risk of recurrence.

Significance of Striated Muscle in Curettings of the Prostate

The histological specimens from 70 patients who underwent transurethral resection of the prostate were reviewed to determine the presence of striated muscle. The patients were evaluated prospectively with preoperative and postoperative symptom analysis and uroflowmetry. Striated muscle was found in 22 of the 70 specimens (31 per cent), generally only in small amounts. No significant morbidity, such as incontinence, was associated with the presence of striated muscle in the specimens. Small amounts of striated muscle in curettings from transurethral prostatectomy can be regarded as incidental and clinically insignificant.