Objective: Lifestyle and anthropometric factors may influence prostate cancer (PCa) risk, yet evidence remains inconclusive. This study reports the associations between lifestyle and anthropometric factors and clinically significant PCa (csPCa; ISUP grade > 1) among men with clinical suspicion of PCa. Materials and methods: In this registered (NCT06116851), single-institution, prospective cohort trial, men referred for PCa diagnostics due to elevated prostate-specific antigen or abnormal digital rectal examination were included. Subjects underwent prostate diagnostics and completed detailed surveys of lifestyle, medical and family history. Physical activity was measured using a triaxial accelerometer. Anthropometric assessments included body mass index, waist circumference and magnetic resonance imaging-based body composition analyses. Results: Among 298 included men, 143 (48%) were diagnosed with csPCa. In multivariate logistic regression, higher physical activity, measured by step count (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.82–0.99) and active smoking compared to never-smokers (OR: 0.38, 95% CI: 0.14–0.96) were inversely associated with detection of csPCa. Higher prostate-specific antigen density was associated with increased risk (OR: 1.78, 95% CI: 1.39–2.35). Body composition was not associated with csPCa. Study strengths include comprehensive data collection. Primary limitation is partial reliance on self-reported data. Conclusions: Higher measured physical activity was inversely associated with detection of csPCa in men with suspicion of PCa. Active smoking also showed an inverse association. Both findings merit further investigation.
Prostatic hyperplasia is among the most common urological conditions in ageing men, and transurethral resection of the prostate (TUR-P) has long been the standard surgical treatment. The perioperative mortality rate (POMR) is an important quality indicator for surgical care, yet contemporary national Swedish POMR data associated with TUR-P is lacking. AIMS:The primary aim was to assess all-cause mortality up to 90-days following TUR-P in Sweden 2013-2022 and whether there was any temporal trend in POMR. The secondary aim was to assess the impact of patients' characteristics (age, ASA class and indication). MATERIAL AND METHODS:This was an observational, register-based cohort study using data from the Swedish-Perioperative-Register (SPOR). A total of 14,052 TUR-P procedures (KED22) for benign prostatic hyperplasia or prostate cancer were included. Descriptive statistics, ANOVA, chi-square test, and multivariable-logistic regression were applied. RESULTS:A total of 10 patients died within 30-days (0.07%) and 56 within 90-days (0.4%). No difference in annual POMR was seen over the study-period. Increasing age, higher ASA-class and cancer indication were the only independent predictors of 90-day mortality. Patients aged above 80-years had an OR of 7.9 (95% confidence interval [CI]: 2.2-42.3), ASA 4 had an OR of 12.6 (95% CI: 1.7-94.3), and cancer diagnosis had an OR of 4.4 (95% CI: 2.5-7.9) in the multivariable logistic regression. CONCLUSIONS:POMR following TUR-P in Sweden is low and numerically similar to age-adjusted background mortality in the Swedish population up to the age of 70-years. High age, ASA-class and cancer diagnosis are the strongest predictors of postoperative mortality.
OBJECTIVE:This study aimed to assess nationwide trends in registered upper urinary tract stone disease and stone-related procedures in Iceland. MATERIAL AND METHODS:We performed a nationwide retrospective population-based study of adults aged 18 years or older with International Classification of Diseases, 10th revision codes N20, N22 or N23 in national hospital and specialist-care data from 2010 to 2024. Crude and age-standardised incidence rates were calculated per 100,000 adults. Stone-related procedures from 2013 to 2024 were identified using Nordic Classification of Surgical Procedures codes. Temporal trends were analysed using negative binomial regression with population offsets. RESULTS:The cohort included 9,492 adults. Registered incidence ranged from 221 to 260 per 100,000 adults and remained stable (95% confidence interval -0.6% to 0.6%; p = 0.914); age standardisation and alternative case definitions gave the same conclusion. Among patients first registered from 2013 onward, 2,432/7,766 (31%) underwent a stone-related procedure. The procedure rate increased from 124.3 to 236.5 per 100,000 adults, corresponding to a 6% annual increase. Ureteroscopy accounted for 10% of procedure registrations in 2013-2016 and 30% in 2021-2024, while shock wave lithotripsy remained the most common procedure. CONCLUSIONS:Registered upper urinary tract stone incidence remained stable, but treatment activity increased substantially. Ureteroscopy use rose rapidly, although shock wave lithotripsy remained the predominant procedure.
OBJECTIVE:To compare surgical complications, biochemical failure, and mortality rates between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS:All men undergoing radical prostatectomy (1995-2023) at a single academic hospital were included, and preoperative factors, surgical parameters, complications, biochemical failures, and mortality were collected. Generalized linear models and cause-specific Cox regressions stratified by surgical procedure were used. Cumulative incidences of biochemical failure were estimated with the Aalen-Johansen estimator, accounting for death as a competing risk. Analyses of surgical complications were adjusted for age and lymphadenectomy, while positive surgical margins, biochemical failure, and mortality were adjusted for preoperative PSA, pathological lymph node stage, pT category, tumor percentage, ISUP score, age, and year of surgery. RESULTS:A total of 3,477 men were included (ORP: 1,759; RARP: 1,718). RARP was associated with reduced odds of in-hospital complications (adjusted odds ratio [aOR]: 0.28, 95% confidence interval [CI]: 0.11-0.74). RARP was associated with a reduced risk of biochemical failure compared to ORP (unadjusted hazard ratio [HR]: 0.52, 95% CI: 0.29-0.93). No other outcomes or mortality rates differed significantly. CONCLUSION:RARP was superior in terms of complications and non-inferior for oncological outcomes compared to ORP at our center. Although the only randomized trial yet, has not proven any significant improvement in long-term cancer control comparing the open versus robotic approach, RARP seems to have replaced ORP as the gold standard for surgical treatment of localized prostate cancer. However, the overall benefit of RARP in the surgical evolution remains elusive.
OBJECTIVE:The Stockholm3 test combines clinical variables and biomarkers to improve the diagnosis of clinically significant prostate cancer (csPCa). We aimed to validate and compare its performance to prostate-specific antigen (PSA)-based decision-making. MATERIAL AND METHODS:We conducted a prospective observational cohort study at a nationwide Finnish private primary care provider between July 2017 and February 2018. We included 1,379 men scheduled for PSA tests, excluding 74 men with missing PSA results or previously diagnosed prostate cancer. The clinical assessment was based on the PSA value and other clinical parameters, with clinicians unaware of the Stockholm3 result. We compared PSA-based decision-making with counterfactual Stockholm3 reflex testing. RESULTS:Among the 1,305 men, the median age was 58 (interquartile range [IQR]: 51-64). PSA was ≥3 ng/mL in 209/1,305 (16%) men and above the age-specific reference limit in 119/1,305 (9%) men. Among men with PSA ≥1.5 ng/mL, a Stockholm3 Risk Score ≥15% would have selected 44% fewer men for further diagnostic evaluation than PSA ≥3 ng/mL (117/469 vs. 209/469). Over 6 years of registry-based follow-up, men with a Stockholm3 Risk Score ≥15% despite PSA below the age-specific reference limit represented a clinically relevant subgroup with subsequent csPCa diagnoses. The main limitation of this study was its observational design. CONCLUSIONS:The hypothetical clinical implementation of Stockholm3 reflex testing would have reduced referrals, helped standardise decision-making, and identified a different group of men for further diagnostic evaluation.
Objective: To explore differences and similarities in paediatric stone treatment between hospitals in the Nordic countries. Material and methods: A retrospective review of the medical records was performed for children receiving stone treatment in nine Nordic hospitals between January 2014 and December 2023. Variables of interest included diagnostic imaging, treatment modalities, complication rates and stone free rates (SFR). Results: Five hundred and sixty two treatments among 319 children were included; 117 girls and 202 boys with a median age of 10 years (interquartile range 5 – 14). Preoperative diagnostic imaging with computed tomography was performed in 442 cases (79%), and 120 patients (21%) were diagnosed with ultrasound, MRI or X-ray. In 150 cases (27%), stones treated were located in the ureter only and in 412 cases (73%) in the renal pelvis ± ureter. Ureteroscopic stone treatment (URS) was performed in 248 (44%), shock wave lithotripsy (SWL) in 242 (43%) and percutaneous lithotripsy (PCNL) in 72 cases (13%). The distribution of treatment modalities varied considerably between hospitals. URS treatments increased, and SWL procedures declined throughout the study period. A follow-up consultation was carried out in 505 cases (90%). Overall SFR after each session across treatment modalities and location was 49%. The SFRs after URS was 68%, SWL 30% and PCNL 61% and significantly higher after URS compared to SWL, p < 0.001. Postoperative complications leading to readmission occurred in 10% of patients. Conclusion: The study reveals differences in preferred treatment modalities and results between the hospitals. Standardising diagnostics, treatment and follow-up could improve outcomes for children with kidney stone disease.
Objective: To investigate histopathological assessment practices following medical circumcision, analyse the prevalence of lichen sclerosus (LS) and assess the management of circumcised LS patients. Material and methods: This retrospective study was conducted at Umeå University Hospital. A total of 416 patients aged ≥18 years who underwent medical circumcision between 2016 and 2023 were included. The variables investigated were the frequency of histopathological diagnosis of preputial tissue, pre- and post-surgery treatment, further management and the prevalence of LS. Results: The mean (standard deviation [SD]) age of included patients was 47 (21) years. Before circumcision, 34% (141/416) of the study population had received treatment with potent or ultrapotent topical corticosteroids. A pre-operative diagnosis of LS was set in 4.8% (20/416) of the patients. Histopathological analysis of circumcised material was performed in 44% (183/416) of cases. Amongst these, LS was confirmed in 60% (110/183). Amongst the patients with histologically confirmed LS, 13% (14/110) received a recorded diagnosis of LS. A total of 15% (16/110) of the patients with LS were either referred to a dermatovenereologist and/or received treatment with an ultrapotent topical corticosteroid. Conclusions: LS appears to be both underdiagnosed and not adequately treated in patients undergoing medical circumcision. Less than half of the circumcised specimens were analysed, which means a risk of missing LS and potential dysplastic changes. Most patients with LS did not receive adequate diagnosis and treatment after surgery. Failure to diagnose LS limits patient awareness, follow-up and appropriate care, factors that may contribute to disease progression and increased cancer risk.
Objective: To determine whether asymptomatic bacteriuria (ABU) prior to Bacillus Calmette-Guérin (BCG) immunotherapy has an impact on the oncological results and overall tolerability of BCG treatment in patients with non-muscle-invasive bladder cancer (NMIBC). Materials and methods: We analyzed retrospectively all patients who received ≥ 1 BCG instillations as treatment of NMIBC in Helsinki University Hospital and Turku University Hospital during 2009–2018. Patients submitted urine specimen 1–7 days prior to the initiation of BCG therapy. ABU was classified as having any positive urine culture but no dysuria or fever. Our primary endpoints were 5-yr recurrence-free survival and progression-free survival. Discontinuation rate of BCG therapy was a secondary endpoint. Results: We identified 795 patients, of whom 154 (19%) had ABU prior to the first BCG instillation. The 5-yr recurrence-free survival rates in the uninfected and bacteriuric groups were 63% (95% confidence interval [CI]: 59–67%) vs. 69% (95% CI: 62–78%), respectively (hazard ratio [HR] 0.83, 95% CI 0.60–1.14). The 5-yr progression-free survival rates were 88% (95% CI: 86–90%) vs. 89% (95% CI: 84–94%), respectively (HR 0.86, 95% CI 0.50–1.49). The 3-yr discontinuation-free survival rates were 51% (95% CI: 47–54%) vs. 51% (95% CI: 44–60%), respectively (HR 0.98, 95% CI 0.75–1.28). Conclusion: ABU did not significantly affect BCG immunotherapy outcomes. Intravesical BCG during ABU is safe, with similar discontinuation rates, indicating very similar treatment tolerability.
Objective: This article presents a summary of the 2025 Swedish prostate cancer guidelines, focusing on recurrence after local treatment, metastatic disease, and castration-resistant prostate cancer. Results: The 2025 Swedish guidelines introduce several important updates. Prostate specific membrane antigen (PSMA)-PET/CT is recommended only when PSA exceeds 0.2 µg/L, and reporting should follow the defined PSMA-RADS-scale. PSMA-PET/CT is preferred over lymph-node dissection for staging. A strong recommendation is issued for radiotherapy to the primary tumour in all oligometastatic men with a life expectancy > 5 years, whereas metastasis-directed therapy is restricted to clinical trials. Systemic treatment pathways now prioritise androgen receptor pathway inhibitors (ARPI) plus androgen deprivation therapy (ADT), with triple therapy (including docetaxel) used more selectively. Pathway-specific staging algorithms have been revised. The oly (ADP-ribose) polymerase inhibitor (PARPi) section has expanded, with broader genomic-based selection and integration into treatment sequencing. Two new chapters and an appendix address cardiovascular risk assessment before ARPI or chemotherapy. Supportive care is substantially strengthened. Compared with the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2025, the Swedish guidelines 2025 applies PSMA-PET/CT more conservatively, restricts PSMA-guided nodal salvage therapy, and issues a more universal recommendation for local radiotherapy in oligometastatic disease. The Swedish guidelines 2025 prioritise ARPI + ADT and limit triple therapy and PARPi combinations due to regulatory and reimbursement constraints. PARPi are largely reserved for BRCA1/2-mutated disease. The Swedish guidelines 2025 provide a more comprehensive framework for rehabilitation and survivorship. Conclusions: The 2025 Swedish prostate cancer guidelines introduce multiple new recommendations and differ in several aspects from the European guidelines.
Introduction: Transurethral resection of bladder tumor (TURBT) is the standard treatment for non-muscle-invasive bladder cancer (NMIBC), but early recurrences remain frequent. The objective of this study was to standardize TURBT management at our institution through the implementation of a treatment protocol designed to reduce early recurrence after primary TURBT. Material and methods: All patients with newly diagnosed NMIBC who underwent primary TURBT at Landspítali University Hospital between 2013–2015 (control) and 2017–2019 (intervention) were included. The treatment protocol restricted procedures to four surgeons, mandated blue-light cystoscopy, routine postoperative bladder irrigation, and guideline-based instillation therapy. The primary endpoint was recurrence rate at first follow-up cystoscopy; secondary endpoints included adherence to protocol measures and recurrence-free survival. Results: A total of 133 control and 138 intervention patients were included. Baseline characteristics were comparable. After implementation, bladder irrigation increased from 46 to 90%, blue-light cystoscopy was used in 59% of intervention cases, and instillation therapy rates rose (Mitomycin-C: 0–49% in intermediate-risk; Bacillus Calmette-Guérin (BCG):35–63% in high-risk patients). Early recurrence rates remained comparable (15% vs. 16%). Early recurrence varied markedly between surgeons (11–40%) and correlated strongly with detrusor muscle presence. No significant difference in recurrence-free survival was observed, though a trend toward lower recurrence was seen in the intervention group after adjusting for risk factors. Conclusion: Implementation of a standardized TURBT protocol improved adherence to recommended measures but did not reduce early recurrence. Marked inter-surgeon variability highlights surgical quality as the key determinant of early recurrence in non-muscle-invasive bladder cancer.
The International Bladder Cancer Group (IBCG) has proposed a prognostic model for intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) for clinical decision-making. We applied the IBCG IR model in a population-based Swedish setting in patients with primary IR NMIBC diagnosed 2013–2014 in BladderBaSe 2.0. Patients were stratified into low-risk (unifocal and tumour size < 3 cm) and intermediate-risk (multiple and/or tumour size ≥ 3 cm) for estimation of 1- and 3-year recurrence-free survival (RFS). Among 710 patients with IR NMIBC, 329 (46%) and 381 (54%) were categorized as low- and intermediate-risk, respectively. Probabilities of disease recurrence or death at 1 and 3 years in low-risk patients were 19% (95% confidence interval [CI]: 15–23) and 41% (95% CI: 35–46), versus 27% (95% CI: 22–31) and 45% (95% CI: 40–50) in the intermediate-risk group. In a sensitivity analysis including only patients receiving serial adjuvant instillations (n = 152) the corresponding probabilities at 1 and 3 years were 19% (95% CI: 10–28) and 33% (95% CI: 22–43) versus 15% (95% CI: 7–23) and 31% (95% CI: 20–41), respectively. Thus, no clinically meaningful difference in recurrence-free survival was observed between International Bladder Cancer Group low- and intermediate-risk groups in this population-based primary non-muscle invasive bladder cancer setting.
PURPOSE:To assess the risk of Achilles tendon rupture (ATR) following single-dose ciprofloxacin prophylaxis for transrectal prostate biopsy. METHODS:Using the Prostate Cancer data Base Sweden (PCBaSe 5.0), we analysed 44,959 prostate biopsy exposures versus 662,520 non-exposures to assess the risk of ATR. Prostate biopsy served as a proxy for quinolone use, with single-dose ciprofloxacin being the recommended and most extensively documented prophylaxis in Sweden for this procedure. The outcome was ATR in men who underwent a biopsy compared to those who did not. RESULTS:The incidence rate of ATR was 60.46 per 100,000 person-years in the no-biopsy group, compared to 62,77 per 100,000 person-years in the biopsy group. The multivariable analysis yielded a hazard ratio of 0.98 (95% confidence interval [CI]: 0.83-1.15). CONCLUSIONS:Transrectal prostate biopsy was not associated with an elevated risk of Achilles tendon rupture. This provides some evidence against single-dose ciprofloxacin being a relevant risk factor for this outcome, but there is remaining uncertainty related to study limitations.
Objective: Retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancer is a complex procedure associated with postoperative complications and long-term morbidity, best performed by experienced surgeons at high-volume centers. This study evaluates surgical outcomes of RPLND in a centralized population-based cohort. Methods: This is a retrospective analysis of a prospective multicenter cohort of all RPLNDs in Sweden between 2018 and 2022. 217 patients (175 nonseminomas and 42 seminomas) underwent unilateral or bilateral primary RPLND or post-chemotherapy RPLND. Primary outcomes were complications, loss of ejaculation, and histopathology. Results: Intraoperative complications occurred in 8% of unilateral and 0% of bilateral templates in primary RPLND, and in 0 and 8% in post-chemotherapy RPLND, most commonly renal injury. Postoperative complications rate was significantly higher with bilateral templates in post-chemotherapy RPLND (49% vs 18%, p < 0.01). Clavien-Dindo ≥ IIIb complications occurred in 2 (primary) and 3% (post-chemotherapy), respectively. Loss of ejaculation was numerically more common after bilateral templates (primary: 60% vs 31%, p = 0.07; post-chemotherapy: 53% vs 38%, p = 0.09). Viable cancer was found in 95% of seminomas and 52% of nonseminomas for primary RPLND and in nonseminoma post-chemotherapy RPLND, 11% viable cancer, 50% teratoma, and 39% benign nodes. Robotic surgery did not increase complications or loss of ejaculation. Conclusions: RPLND demonstrated low complication rates and rare serious events. Bilateral templates were associated with increased loss of ejaculation. Robotic surgery was safe, and prior chemotherapy did not preclude laparoscopy. Post-chemotherapy RPLND showed more teratoma and viable cancer, and fewer benign findings than previously reported.
BACKGROUND:We aimed to evaluate the safety and efficacy of transurethral resection/electrocautery for the treatment of urethral hemangiomas. METHODS:A retrospective analysis was conducted on clinical data from patients who underwent transurethral resection/electrocautery for urethral hemangiomas at two medical institutions between August 2018 and July 2025. Perioperative data, short-term and long-term complications, and tumor recurrence were assessed. RESULTS:In total, 42 patients were included in this study. All patients successfully underwent surgical treatment without any intraoperative complications and residual tumor. The procedures were completed in a median operative length of 10 min (interquartile range [IQR]: 10-15 min) and a median blood loss volume of 20 mL (IQR: 10-20 mL). Most patients (n = 39, 92%) presented multiple lesions, with a median size of 4 mm (IQR: 3-4 mm). The lesion range of the 31 patients (74%) was more than one-half of the circumferential diameter in cystourethroscopy. Postoperative complications occurred in five patients (12%), primarily consisting of difficult urination (n = 4, 10%) and gross hematuria (n = 1, 2%). The median follow-up times were 12.0 months (IQR: 8.0-38.5 months), and one patient developed recurrence 4 months after surgery. Long-term complications, such as urethral stricture, urinary incontinence, and retrograde ejaculation, were observed. CONCLUSION:Transurethral resection/electrocautery provides a safe, effective, and feasible treatment for urethral hemangiomas, delivering swift hemostasis with very low rates of complications and recurrence. Although this study included the largest sample size currently available worldwide, the findings still need additional validation.
OBJECTIVE:It is unknown how risk factors for infection after transrectal prostate biopsy interact. We designed a study to evaluate this. METHODS:We identified biopsy procedures from 2006 to 2020 in the Swedish nationwide database PCBaSe. Primary outcome was post-biopsy infection, defined as a dispensed prescription of a urinary tract antibiotic and secondary outcome was inpatient care for infection both within 30 days. Risk factors were age, diabetes, medical treatment of lower urinary tract symptoms (LUTSs), prostate enlargement, immunosuppressives, corticosteroids, and defined antibiotic exposure during the past 1-12 months. When analysing risk in men with several risk factors clinically related factors were grouped as urinary tract infection (UTI)-antibiotics, treatment of LUTS, immunosuppressives including corticosteroids, and diabetes. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI). RESULTS:A total of 139,056 transrectal prostate biopsy procedures were analysed. The grouped risk factors were significantly associated with post-biopsy infection (multivariable ORs: 1.22-1.72). Infection increased with number of risk factors; none: 4.0% (95% CI: 3.8-4.1), one: 6% (95% CI: 5.9-6.4), two: 10% (95% CI: 9.3-11), and three or four: 12% (95% CI: 9.8-14); inpatient care increased from 2.0% (95% CI: 1.9-2.1) to 3.1% (95% CI: 2.2-4.4). CONCLUSION:Infection risk after transrectal prostate biopsy incrementally increases with the number of risk factors. CLINICAL IMPLICATIONS:The transrectal biopsy route should be used with caution for patients with several risk factors for post-biopsy infections. PATIENT SUMMARY:Diabetes, urinary symptoms, previous urinary infection, and immune suppressing medication increase the risk of infection after a prostate biopsy through the rectum. Patients with many of these conditions have a particularly high risk. What does the study add? We used nationwide register data to estimate the infection risk after transrectal prostate biopsy by the number of these risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year. The risk incrementally increased from 4.0% in men with no risk factor to 12% in those with 3 or 4. TAKE HOME MESSAGE:Infection after transrectal prostate biopsy increases with number of risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year, from 4.0% (none) to 12% (3 or 4).
OBJECTIVE:Testicular torsion (TT) is a medical emergency, difficult to identify solely through clinical evaluation. This study aims to develop an assessment algorithm with a safe lower threshold for complementary ultrasound. MATERIAL AND METHODS:Males between 1 and 30 years of age assessed for suspected TT during the years 2019 - 2023 were retrospectively included. Clinical assessments were conducted by primarily nonurologists and ultrasounds by radiologists. An assessment algorithm named Testicular torsion Point-based Assessment and Imaging tool - identifying Need for Surgical exploration (TPAINS) was developed based on symptoms showing significant correlation with TT. RESULTS:Of the 417 patients included, 68 (16%) were surgically explored and 33 (8%) diagnosed with TT. Six symptoms showing a significant association with TT were combined for the development of the algorithm TPAINS. With a cut-off value of ≥2 points, TPAINS showed a sensitivity of 100% (confidence interval, CI: [90, 100]), specificity 54% (CI [49 - 59]), and an AUC-value of 0.89 (95% CI [84 - 94]). CONCLUSIONS:This study concludes that symptom-based evaluation, together with a low threshold for ultrasound, is a promising approach for the detection of TT. The developed algorithm, TPAINS, includes an ultrasound assessment and focuses on safe lower thresholds for further clinical actions - hoping for a reduced rate of unnecessary surgical explorations.
INTRODUCTION:Up to 20% of aging men have low serum testosterone (late-onset hypogonadism [LOH]), and approximately 80% develop benign prostatic enlargement (BPE) with increasing age. Both age and prostate size are linked to lower urinary tract symptoms (LUTS). This study aimed to evaluate the effect of testosterone replacement therapy (TRT) on prostate volume and LUTS in men with LOH. MATERIALS AND METHODS:From 2004 to 2017, 511 men underwent annual checkups including physical examination, transrectal ultrasound, bladder scanning, serum Prostate-Specific Antigen (s-PSA), and serum testosterone and questionnaires on LUTS and LOH symptoms. None had prior treatments affecting prostate size or LUTS at baseline. During the annual follow-ups, 167 men (33%) were diagnosed with symptomatic LOH and received TRT. A longitudinal statistical model was used to compare periods with and without treatment regarding prostate growth, post-void residual urine, IPSS (International Prostate Symptom Score), quality of life (QoL), and s-PSA. RESULTS:Participants contributed 3745 visits (median 7 per man), including 904 (24%) after testosterone initiation. TRT was associated with a mean increase in prostate growth rate of 0.22 mL/year compared with untreated periods (p = 0.023). No significant differences were observed in LUTS, QoL, or s-PSA between treated and untreated periods Conclusion: In ageing males with late-onset hypogonadism, testosterone replacement therapy was linked to a small but statistically significant increase in prostate growth rate without measurable effects on urinary symptoms.
BACKGROUND:Muscle invasive bladder cancer (MIBC) is an aggressive disease with a high mortality rate. Radical cystectomy (RC) is the standard treatment for MIBC and selected non-muscle invasive bladder -cancer (NMIBC) cases. The NorCys-study (NCT04523038, NCT04537221 and NCT04523025) aims to validate biomarkers predicting RC outcomes. This report describes RC practice patterns across the Nordic countries. MATERIALS AND METHODS:This prospective, multi-institutional study included bladder cancer patients undergoing RC with or without preoperative chemotherapy in all five Nordic countries from 5/2020 to 1/2025. Clinical and pathological data were collected prospectively into REDCap database and analysed using descriptive statistics, Wilcoxon rank sum and Pearson's Chi-squared tests. RESULTS:A total of 1,642 patients from 15 centres were enrolled. Of these, 35% (531) had clinical NMIBC (T1-Tis-Ta), and 65% (999) had cT2-4 disease. Preoperative chemotherapy was administered to 398/929 (43%) cT2-4 or node-positive patients. The most common neoadjuvant chemotherapy (NAC) regimens were gemcitabine - cisplatin (GC) (275/475 [58%]) and dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) (144/475 [30%]). Robot-assisted RC was the most common surgical approach administered in 886 of 1,472 (60%) cases, with variation between centres. Ileal conduit was the predominant diversion method in 1,375 out of 1,465 cases (94%). Median surgical time was 322 min, blood loss was 300 mL and hospital stay was 9 days. Final pathology demonstrated pT0 in 29%, ≥pT2 in 43% and lymph node metastases 203 (17%). CONCLUSION:This study reports current RC practices amongst Nordic countries. Patient cohorts did not differ between countries, and although the practices were generally similar, some differences were noted in chemotherapy regimens, the use of robotic-assisted surgery and rates of early RC.
OBJECTIVE:This study aimed to evaluate the feasibility of thermal imaging for the diagnosis of acute testicular pain. Pain is usually caused by infection, inflammation or torsion of the testis or testicular appendage. Diagnosis is based on examination, laboratory tests, and Doppler ultrasound (DU), which is investigator dependent and may cause delays. Thermal imaging is a fast and noninvasive method for measuring surface temperature. MATERIALS AND METHODS:Our 3-month pilot study investigated the feasibility of thermal imaging for the diagnosis of acute testicular pain. Eighteen consecutive patients were examined using a thermal camera. RESULTS:Two patients had testicular torsion (group 1), two had torsion of the testicular appendage (group 2), four had bacterial epididymitis (group 3), and 10 had inflammatory epididymitis (group 4). The mean ± standard deviation (SD) temperature differences between symptomatic and a reference asymptomatic testicles were -0.65 ± 0.57°C (range, -1.1 to -0.2°C), -0.15 ± 0.21°C (range, -0.3 to 0.0°C), +0.65 ± 0.25°C (range, +0.4 to +1.0°C), and +0.39 ± 0.87°C (range, -1.0 to +1.8°C) in groups 1, 2, 3, and 4, respectively. CONCLUSIONS:Thermal imaging is a feasible, noninvasive method for evaluating acute testicular pain. It may serve as a rapid diagnostic tool, but its clinical value must be confirmed in large prospective trials.
Objective: Chronic inflammation of the urinary bladder is associated with the bladder pain syndrome. The treatment alternatives in humans are far from satisfactory and need further attention. Well-established preclinical models have shown that pro-inflammatory cytokines contribute to the progress of the inflammatory response behind pain and hyperalgesia. Previously presented results indicate that treatment with CernitinTM pollen extracts active pharmaceutical ingredients (APIs) (Cernitin GBX and Cernitin T60) significantly alleviated pain in cyclophosphamide-induced urinary bladder inflammation in a rodent model through downregulation of PGD2 and cyclooxygenase-2 (COX-2) mediators when compared to the vehicle alone. The objective was to extend the original study by exploring the correlation between the two APIs and cytokines expression and to identify a possible biomarker pattern. Material and method: The Olink® Target 48 Mouse Cytokine assay was conducted on the homogenised tissue extracts of the bladder wall with induced inflammation from a previous study to identify the potential impacts on protein biomarkers. Results: The test revealed that treatment with the APIs significantly downregulated the cytokines interleukin (IL)-1α, IL-2, IL-4, IL-6, and with trend to significance the biomarkers IL-12 α, β, CCL4 and fibroblast growth factor 21 when administered in combination (GBX+T60) or each component alone, compared to vehicle controls. Conclusion: This study identified seven cytokines that were significantly or markedly reduced. The results suggest that CernitinTM APIs impact a series of key pro-inflammatory biomarkers demonstrating an ability to restrain inflammation. Therefore, they warrant further investigation as potential therapeutic candidates
