Scandinavian Journal of Urology and Nephrology

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ISSN / EISSN : 0036-5599 / 1651-2065
Published by: Informa UK Limited (10.3109)
Total articles ≅ 3,691
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Scandinavian Journal of Urology and Nephrology, Volume 46, pp 396-396; doi:10.3109/00365599.2012.748302

, Marcus Baumann, Tibor Schuster, Michael Fischereder, Bernhard K. Krämer, Uwe Heemann, Jens Lutz
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 466-474; doi:10.3109/00365599.2012.726643

Objective. BK virus (BKV)-induced viraemia after renal transplantation can be associated with severe impairment of graft function. This study evaluated possible risk factors for BKV replication and examined the outcomes following various currently used treatment approaches. Material and methods. Fifty-seven renal transplant recipients with BKV viraemia were retrospectively compared with 71 BKV-negative recipients to identify risk factors for BKV viraemia. Furthermore, outcome and graft function in 14 patients with BKV replication, in whom mycophenolate mofetil (MMF) was discontinued with a dose reduction of the remaining immunosuppressants, were compared with 32 patients in whom both MMF and the additional immunosuppressants were reduced. Results. Patients with BKV viraemia received MMF (p < 0.01) and triple immunosuppression (p < 0.01) significantly more often, and displayed tacrolimus (p = 0.034) at higher blood concentrations (p = 0.002), a lower lymphocyte count (p = 0.006) and a longer warm ischaemic time (p = 0.019), and were more often male (p = 0.026). Patients in whom MMF was stopped had a higher chance of clearance of BKV viraemia (p = 0.022), which was achieved more rapidly (p = 0.048). Graft function improved during treatment and no graft losses occurred, compared with eight graft losses in the MMF-treated group (p = 0.04). Conclusions. MMF and tacrolimus could promote BKV viraemia after renal transplantation. Discontinuation of MMF together with a reduction of calcineurin inhibitors and glucocorticoids could be an option to reduce BKV replication after renal transplantation.
Seok Hui Kang, Kyu Hyang Cho, Jong Won Park, Kyung Woo Yoon,
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 454-460; doi:10.3109/00365599.2012.700643

Objective. Few studies have linked changes in bone mineral density (BMD) in peritoneal dialysis (PD) patients to the calcium concentration in peritoneal dialysate. Material and methods. In total, 236 incident patients who underwent an annual BMD determination for 2 years were enrolled. The patients were divided into two groups: the standard calcium dialysate (SCD) group (n = 190; 1.75 mmol/l) and the low-calcium dialysate (LCD) group (n = 46; 1.25 mmol/l). Results. There were no significant differences between the baseline demographics of the two groups, such as age, diabetes, calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone (i-PTH) levels or variables related to BMD. Univariate and multivariate analyses [adjusted for age, gender and time-averaged 25(OH)-vitamin D] determined that the LCD group had higher time-averaged i-PTH and ALP and a greater decrease in bone mineral content, lumbar spine BMD, subtotal BMD and total BMD compared to the SCD group. Conclusion. LCD is associated with a more rapid decline in BMD, higher i-PTH and higher ALP in PD patients. It is suggested that LCD be avoided for PD patients a trisk of osteoporosis and hyperparathyroidism.
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 461-465; doi:10.3109/00365599.2012.708943

Objective. The aim of this study was to evaluate the association of tissue-type plasminogen activator (t-PA) levels with clinical data of patients under haemodialysis (HD) and with several variables potentially related to endothelial function and dysfunction. Material and methods. In a cross-sectional study involving 189 Portuguese HD patients, circulating levels of t-PA, lipids, oxidized low-density lipoprotein (Ox-LDL), interleukin-6 (IL-6), C-reactive protein (CRP), adiponectin, plasminogen activator inhibitor type 1 (PAI-1) and fibrin fragment D-dimer were measured. Results. Considering the entire population, t-PA correlated inversely and significantly with adiponectin and high-density lipoprotein-cholesterol, and positively and significantly with age, body mass index, PAI-1, IL-6, CRP, D-dimer, cholesterol and Ox-LDL. In multiple linear regression analysis PAI-1, age and adiponectin remained statistically associated with t-PA values (p < 0.01 for all). The weakest significant association (p = 0.046) was that found between t-PA and D-dimer. Conclusion. Adiponectin is a main determinant of t-PA level, which may be a good marker of endothelial dysfunction in HD patients.
, , Juha Koskimäki, Matti Hakama, Teuvo L. J. Tammela, Jukka T. Häkkinen
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 418-423; doi:10.3109/00365599.2012.702786

Objective. The aim of this study was to determine the prevalence and bother of postmicturition dribble in relation to age in the male population. Material and methods. Information for a population-based study was collected by means of a mailed self-administered questionnaire, which was returned by 4384 men out of 7470 (58.7%). The participants were men aged 30–80 years from the Pirkanmaa Region in Finland. The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire was used to evaluate their urinary symptoms. SPSS was used in the data analysis. Two-sided chi-squared test and Kendall tau-b test were used for analysis. Results. The overall prevalence of postmicturition dribble was 58.1% (95% confidence interval 56.6–59.6). Prevalence of postmicturition dribble increased with age (p < 0.001). In men aged 60–80 years, two-thirds reported postmicturition dribble and approximately one out of four had dribbling into their trousers after voiding. In the 30-year-old group, over 40% reported postmicturition dribble and almost one out of five had also dribbling into their trousers. One out of five men in the 30-year-old group reported minor bother; the proportion of men reporting bother increased with age to one-third of the men in the oldest cohort (p < 0.001). Conclusions. The prevalence of the postmicturition dribble was found to be high in this survey. Half of the 30-year-old men and two-thirds of the men aged 60–80 years had postmicturition dribble. Dribbling into trousers increased with age but as a severe symptom, it was rare (0.5%). Minor problems from postmicturition dribble were common, but major bother occurred seldom (1.1%).
, Eero Kaasinen, Erkki Rintala, The Finnbladder Group
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 411-417; doi:10.3109/00365599.2012.694906

Only a few studies with a long-term follow-up exist on patients with carcinoma in situ (CIS) treated with instillation therapy. The objective was to study the long-term outcome of patients with CIS after mitomycin C (MMC) monotherapy or alternating therapy with MMC and bacillus Calmette-Guérin (BCG). The study population comprised 68 patients with CIS belonging to a larger material of 256 patients with non-muscle-invasive bladder carcinoma who were randomized between 1987 and 1992 in a prospective multicentre study. Patients received the same induction period with MMC and continued with maintenance treatment comprising either monthly instillations of MMC alone or alternating MMC and BCG instillations for up to 2 years. Primary endpoints were cancer-specific and overall mortality. Secondary endpoints were time to first recurrence and time to progression. The principal statistical methods were the Kaplan-Meier method and cumulative incidence analysis. The overall median follow-up time of the patients with CIS was 7.2 years and the median follow-up time of the patients still alive was 17.1 years. The non-stratified probability of dying from bladder carcinoma at 5, 10 and 15 years was 13%, 25% and 28%, respectively. No significant difference was found between the study groups with respect to time to first recurrence, progression, or disease-specific or overall mortality. The long-term bladder cancer-specific mortality was unexpectedly low despite the relatively ineffective instillation therapy and the poor outcome of the patients after progression.
Nore Kaerts, Alexandra Vermandel, Frauke Lierman, Ans Van Gestel,
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 424-430; doi:10.3109/00365599.2012.693537

Objective. The aims of this study were to check the possibility of observing readiness signs proposed in the literature (Study 1) and to investigate the interrater reliability of observing readiness signs between different researchers (Study 2). Material and methods. In Study 1, 24 healthy children, recruited in Flemish childcare centres, were observed. Each child was observed for 8 h. In this study a list of readiness signs was used as described in a recent literature review on readiness signs in young, healthy children. In Study 2, two observers independently evaluated an adapted list with readiness signs in another 24 healthy children recruited in a similar setting. SPSS was used to analyse the interrater reliability between these observations, calculating Cohen's kappa per readiness sign. Results. The results of Study 1 show that not all readiness signs are easy to assess. This resulted in a shortened checklist with 20 signs, which can be easily observed in young, healthy children during an 8 h period, and which was used in Study 2. The results of Study 2 show that, for most readiness signs, Cohen's kappa and the agreement between observers varied from good to perfect. Conclusions. This article presents the results of two studies that are the first in a series investigating the use of readiness signs. Further research on readiness signs is being conducted to reach consensus on when to start toilet training based on readiness signs, and to obtain evidence-based guidelines.
, Swen-Olof Andersson, Jan-Erik Johansson, Torgny Windahl
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 319-325; doi:10.3109/00365599.2012.677473

Objective.This study aimed to assess initial symptoms and factors associated with patients' and doctors' delay in penile carcinoma. Material and methods. Fifty consecutive patients with penile carcinoma treated with an organ-sparing technique and nine with partial amputation were enrolled in a prospective study at the Department of Urology, Örebro University Hospital, between 2005 and 2009. Face-to-face structured interviews in combination with self-assessment forms were used for the patients' descriptions of clinical symptoms, treatment seeking and reasons for delay. Data were also extracted from the medical records confirming time-lag between GP assessment, specialist care and time for diagnosis. Results.Erythema, rash and eczema were the most common initial symptoms (35%). In total, 65% had a patients' delay of more than 6 months, and among these there was a small, but not statistically significant, predominance for pT1 and pTis tumours. Living with a stable partner did not affect the delay. The most common reason for patients' delay was the feeling of embarrassment over symptoms localized in a sexual body area. Nine patients had a doctors' delay of more than 3 months from first special visit to diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results. Conclusions.A considerable proportion of the patients had a patients' delay of more than 6 months, perhaps due to benign initial symptoms as erythema, rash or eczema. Psychological factors such as embarrassment and denial may also be involved, as well as insufficient awareness or knowledge.
Steffan Robstad Nilssen, Siv Mørkved, Mari Overgård, Stian Lydersen,
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 397-404; doi:10.3109/00365599.2012.694117

Objective. The aim of this study was to study the effect of postoperative physiotherapist-guided pelvic floor muscle training (PFMT) on health-related quality of life (HRQoL) parameters in patients treated with radical prostatectomy (RP). Material and methods. A prospective randomized controlled trial was conducted at St. Olavs Hospital, Trondheim University Hospital, Norway. Eighty-five men were randomized into two intervention groups (A and B). patients in group A (n = 42) were offered physiotherapist-guided PFMT (in groups or by DVD) once weekly throughout the first 12 months after RP, while those in group B (n = 43) trained on their own. HRQoL data were assessed using the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) and the Short Form-12 (SF-12) health survey. The physical component summary (PCS) and mental component summary (MCS) scores of the SF-12 plus the urinary, sexual and bowel function and bother of the UCLA-PCI make up the eight quality of life outcomes used in this study. Data were obtained preoperatively (baseline), 6 weeks, and 3, 6 and 12 months postoperatively. Results. Eighty patients completed at least one follow-up assessment, 38 in group A and 42 in group B, giving a dropout rate of 5.9%. The overall response rates were 96% at baseline, 83% at 6 weeks, 90% at 3 months, 88% at 6 months and 68% at 12 months. No statistically significant difference in HRQoL was found between groups A and B. Conclusions. Even though physiotherapist-guided training of the pelvic floor muscles after RP improved postoperative urinary incontinence significantly compared to those patients receiving standard care/training, this was not reflected in better outcome in HRQoL parameters.
, Johan Vestergaard Povlsen, Kent Lodberg Christensen
Scandinavian Journal of Urology and Nephrology, Volume 46, pp 381-388; doi:10.3109/00365599.2012.693131

Objective. Left ventricular hypertrophy (LVH) is highly prevalent in chronic kidney disease (CKD) and a risk marker for cardiovascular mortality. It was hypothesized that vitamin D deficiency could play an important role in the pathogenesis of left ventricular hypertrophy and dysfunction in CKD. An open-labelled randomized study was performed comparing the effect of alfacalcidol versus no treatment in patients with CKD 4, secondary hyperparathyroidism and LVH. The primary endpoint was regression of LVH. Secondary endpoints were changes in left ventricular function. Material and methods. Twenty-four patients were screened. Of these, 14 had LVH according to the criteria used. Six were randomized to alfacalcidol and seven to no treatment. The patient follow-up was 6 months. Left ventricular mass and function were measured by echocardiography. Results. Parathyroid hormone decreased by 72% and –3% in the alfacalcidol-treated and non-treated groups, respectively (p < 0.05), while serum Ca2+ increased by 9% and –1.6%, respectively (p < 0.05), and serum phosphate was unchanged. The left ventricular mass index was unchanged, whereas fractional shortening (20% vs 2%, p < 0.005) and Tei index (36% vs 12%, p < 0.05) increased significantly. Systolic and diastolic blood pressure was unchanged. Conclusion. Short-term treatment with alfacalcidol did not induce regression of LVH; however, left ventricular function became hyperdynamic but less effective in patients with CKD. This could be problematic in the long term.
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