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  • 1.
    Jerlström, Tomas
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Andersson, Gunnel
    Örebro University Hospital, Örebro, Sweden.
    Carringer, Malcolm
    Örebro University Hospital, Örebro, Sweden.
    Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder2010In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 4, p. 197-203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare the functional outcome of two types of orthotopic bladder substitution, the S-shaped and the U-shaped neobladder, with respect to leakage, functional capacity and quality of life.

    MATERIAL AND METHODS: Between 1999 and 2007, 45 male patients with urinary bladder cancer were treated with cystectomy and orthotopic bladder substitution; 23 with the S-shaped bladder ad modum Schreiter and 22 with the U-shaped bladder ad modum Studer. Patients were followed up by a urologist and a specialized nurse (urotherapist) at 1, 3 and 6 months. At each visit the patient completed a voiding chart, a weighted pad test and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Differences between the groups in functional outcome and quality of life variables were analysed by Student's t test using SPSS software.

    RESULTS: Mean maximum bladder capacity increased over time. At 6 months, the S-bladder had a larger capacity than the U-bladder (525 ml vs 423 ml). Patients with an S-bladder had less urine leakage at all follow-ups, although this was statistically significant only at 6 months regarding day-time incontinence and at all visits regarding night-time incontinence. The mean urine leakage at 6 months was 7 g (day) and 30 g (night) in the S-bladder group and 50 g (day) and 250 g (night) in the U-bladder group. However, quality of life did not differ between the groups.

    CONCLUSION: The S-bladder had better bladder capacity and less leakage than the U-bladder, but these differences did not translate into differences in quality of life. The results should be confirmed in larger prospective studies.

  • 2.
    Jerlström, Tomas
    et al.
    Department of Urology, University Hospital, Örebro, Sweden.
    Gardmark, Truls
    Dept Surg & Urol, Danderyd Hosp, Danderyd, Sweden.
    Carringer, Malcolm
    Örebro University Hospital. Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Holmang, Sten
    Dept Urol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Liedberg, Fredrik
    Dept Urol, Skåne Univ Hosp, Malmö, Sweden.
    Hosseini, Abolfazl
    Dept Mol Med & Surg, Urol Sect, Karolinska Inst, Stockholm, Sweden.
    Malmström, Per-Uno
    Dept Surg Sci, Uppsala Univ, Uppsala, Sweden.
    Ljungberg, Börje
    Dept Surg & Perioperat Sci Urol & Androl, Norrlands Univ Hosp, Umeå, Sweden.
    Hagberg, Oskar
    Reg Canc Ctr South, Lund, Sweden.
    Jahnson, Staffan
    Dept Clin & Expt Med, Div Urol, Linköping Univ Hosp, Linköping, Sweden.
    Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database2014In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, no 4, p. 334-340Article in journal (Refereed)
    Abstract [en]

    Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.

    Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.

    Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.

    Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

  • 3.
    Persson, Beata
    et al.
    Dept Urol, Örebro University Hospital, Örebro, Sweden.
    Carringer, Malcolm
    Örebro University Hospital. Dept Urol, Örebro University Hospital, Örebro, Sweden.
    Andren, Ove
    Örebro University Hospital. Dept Urol, Örebro University Hospital, Örebro, Sweden.
    Andersson, Swen-Olof
    Örebro University Hospital. Dept Urol, Örebro University Hospital, Örebro, Sweden.
    Carlsson, Jessica
    Örebro University Hospital. Dept Urol, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Dept Surg, Örebro University Hospital, Örebro, Sweden.
    Initial experiences with the enhanced recovery after surgery (ERAS (R)) protocol in open radical cystectomy2015In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, no 4, p. 302-307Article in journal (Refereed)
    Abstract [en]

    Objective. This article describes the authors' experiences with the implementation of the Enhanced Recovery After Surgery (ERAS (R)) protocol for open radical cystectomy (ORC). Adherence to the ERAS cystectomy protocol was assessed; secondary outcome measures were impact on perioperative complication rate (Clavien-Dindo classification), time to first defecation, postoperative length of stay and hospital readmission rate. Materials and methods. This retrospective feasibility study compared outcomes with patients in a historical control group. The study group (ERAS) consisted of 31 consecutive patients undergoing ORC and urinary diversion during 1 year from 1 January to 31 December 2011. The control group (pre-ERAS) comprised 39 consecutive patients operated on during 2010. Follow-up was 30 days. Results. There were no significant demographic differences between the two groups, and no differences in complications graded Clavien III or above, or in total length of stay. The ERAS group had statistically significantly shorter mean time to first passage of stool and statistically significantly lower readmission frequency than the pre-ERAS group. The number of patients was small and the study was not randomized; moreover, the use of historical controls inevitably introduced different types of bias. Conclusions. Introduction of the ERAS protocol is clearly feasible in cystectomy, and may improve clinical outcomes in terms of faster return of bowel function and reduction of readmission within 30 days. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing ORC.

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