PurposeThe aim of this study was to explore how women experienced sexuality after radical cystectomy due to bladder cancer.MethodsWe performed an interview study with qualitative design with content analysis. Inclusion criteria were age below 75 years. In total 10 women, with a median age of 64 years at surgery, were interviewed at median 24 months post radical cystectomy.ResultsThe 10 women described sexual life as affected after surgery but they all tried to find ways to overcome the new situation together with their partner. The overall theme was 'A balance between emotional and physical closeness' emerged from 30 codes that were condensed into five subcategories and two categories: 'A sensual relationship' and 'A sexual relationship'. The first category constituted the subcategories 'Feeling of intimacy' and 'The importance of the relationship'. The category 'A sexual relationship' was revealed from the subcategories 'Reluctance to engage in sexual activity' and 'Partner inability to engage in sexual activity', and 'Acting for sexual rehabilitation'.ConclusionsThe uncertainty that the women felt about their anatomical changes after radical cystectomy created a sexual anxiety and reluctance to resume intercourse. Even though the surgery had a major impact on their sexual life, the women tried to be sexually active. However, the meaning of sexual life was not just having sexual activity but also included closeness, affirmation, affection, and feeling attractive. Sexual counseling at an appropriate timepoint is essential to assure a balance between emotional and physical closeness, i.e. to regain sexual health.

Objective: The aim of this study was to investigate health-related quality of life (HRQoL) before and 1 year after radical cystectomy in relation to age and gender.Methods: This prospective study involves 112 men and 40 women with bladder cancer treated with radical cystectomy between 2015 and 2018. HRQoL was assessed preoperatively and 1 year post-surgery through Functional Assessment of Cancer Therapy Scale - General (FACT-G) and Functional Assessment of Cancer Therapy Scale - Vanderbilt Cystectomy Index (FACT-VCI) questionnaires. The median age of the 152 patients was 71.5 years.Results: Preoperatively, emotional and functional well-being were negatively affected. Physical, emotional and functional well-being presented higher values 1 year after surgery compared to before radical cystectomy, that is, better HRQoL. Social well-being showed a reduction, especially regarding closeness to partner and support from family. Men and women were equally satisfied with their sex life before radical cystectomy, but less so 1 year after, where men were less satisfied compared to women. Additionally, one out of five patients reported that they had to limit their physical activities, were afraid of being far from a toilet and were dissatisfied with their body appearance after surgery.Conclusions: Recovery regarding HRQoL was ongoing 1 year after radical cystectomy. Patients recovered in three out of four dimensions of HRQoL, but social well-being was still negatively affected 1 year after treatment. Sexual function after radical cystectomy was exceedingly limited for both men and women. An individual sexual rehabilitation plan involving the couple with special intention to encourage intimacy, might not only improve sexual life but also have a positive effect on social well-being as a consequence.

Objective: To prospectively assess anorectal dysfunction using patient-reported outcomes using validated questionnaires, manovolumetry and endoanal ultrasound before and 12 months after RC. Patients and methods: From 2014 to 2019, we prospectively included 44 patients scheduled for RC. Preoperatively and 12 months after surgery, 41 patients filled in a low anterior resection syndrome score (LARS-score) to assess fecal incontinence, increased frequency, urgency and emptying difficulties and a St Mark’s score to assess fecal incontinence in conjunction with manovolumetry and endoanal ultrasound examinations. Pre- and postoperative patient-reported anorectal dysfunction were assessed by LARS-score and St Marks’s score. At the same time-points, anorectal function was evaluated by measuring mean anal resting and maximal squeeze pressures, volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry. Wilcoxon's signed rank test was used to compare pre- and postoperative outcomes by questionnaires. Results: Postoperatively 6/41 (15%) patients reported flatus incontinence assessed by the LARS-questionnaire, and correspondingly the St Mark’s score increased postoperatively. The median anal resting pressure decreased from 57 mmHg preoperatively to 46 mmHg after RC, but without any postoperative anatomic defects detected by endoanal ultrasound. Volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry all increased after RC, indicating decreased postoperative rectal sensation, as rectal compliance was unaltered. Conclusions: Postoperative flatus incontinence is reported by one out of seven patients after RC, which corresponds to decreased anal resting pressures. The finding of decreased rectal sensation might also contribute to patient-reported symptoms and anorectal dysfunction after RC.

A SMARTPHONE APP FOR SELF-MANAGEMENT OF URGENCY AND MIXED URINARY INCONTINENCE : A RANDOMIZED CONTROLLED TRIAL

Hypothesis / aims of study One of the challenges in health care today is providing affordable care for those in need, and identifying a reasonable level of care for care-seekers. Many women with u ...

Purpose: The purpose of this study was to illuminate how men under 65 years of age experience their everyday Life one year or more after a radical prostatectomy for localised prostate cancer. Method: Interviews with 19 men aged under 65 were performed 12-18 months after their radical prostatectomy. The interviews were analysed using a thematic content analysis. Results: The analysis of the interviews revealed three categories of experiences: 'Paying a price for survival', 'Feeling sidestepped' and 'Living with death lurking around the corner'. The side effects of the prostatectomy, such as sexual dysfunction, resulted in a changed self-image with a loss of manliness and reduced self-esteem. The men felt sidestepped and that they did not receive enough support. Prostate cancer was experienced as an embarrassing disease and the men felt their fundamental needs could not be openly discussed. Having cancer was associated with death. Thoughts about death faded away during recovery after the operation, but grew stronger in certain situations and reminded the men about their cancer. Returning to work and to previous activities helped them cope with the thoughts about death. Conclusions: Our study suggests a need for improved rehabilitation after a radical prostatectomy, including more structured sexual rehabilitation, and involving the partner. Sharing the experiences of other men who have undergone prostate cancer surgery may also be beneficial. (C) 2017 Published by Elsevier Ltd.

Irregular or infrequent voiding due to avoiding school toilets can contribute to a number of urinary problems among school children. There is, however, a lack of studies on younger women. The aim of this study was to investigate toileting behavior and the correlation to lower urinary tract symptoms (LUTS) among young women (age 18–25 years). A further aim was to validate the Swedish version of the Toileting Behavior scale (TB scale).

Objective: The aim of this study was to translate and validate the Swedish version of the Functional Assessment of Cancer Therapy Scale - Vanderbilt Cystectomy Index (FACT-VCI).Materials and methods: For adaptation into Swedish, a multiprofessional team was used for translation including cultural adjustment, followed by back-translation. Test and retest in 10 individuals was followed by assessing metric properties in 75 consecutive patients with bladder cancer treated with radical cystectomy. Reliability and internal consistency were measured by Cronbach's alpha. Face validity was tested with two laypersons and construct validity was tested by correlation to the dimensions in the Functional Assessment of Cancer Therapy Scale - General (FACT-G).Results: The translated Swedish instrument showed validity and reliability similar to the original, and the results were comparable to published studies using FACT-VCI. The correlation between the VCI sum score and FACT-G dimensions was significant in all dimensions and the item-total correlation was over 0.3; therefore, the construct validity was acceptable. In addition, it was possible to detect differences in separate items in the translated version of FACT-VCI between age groups, type of diversion and those treated with chemotherapy, even though the samples were small.Conclusions: The Swedish version of FACT-VCI is a valid and reliable instrument for use in the follow-up of patients with bladder cancer treated with urinary diversion. To measure changes after surgery, preoperative assessment with the related FACT-G instrument is advisable.

Objective: Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection. The primary aim of this study was to investigate whether the use of a silicone catheter coated with an ultrathin layer of a combination of the noble metals gold, palladium and silver (BIPTM-silicone catheter) could reduce the incidence of CAUTI and antibiotic prescription compared with a standard silicone catheter in a cohort of acute neurological patients suffering primarily from stroke. At the same time, all infectious events requiring prescription of an antimicrobial agent were registered and are reported.Materials and methods: The study was designed as a crossover cohort study enrolling men and women aged over 18 years, requiring emergency management for stroke including the insertion of an indwelling catheter. Data on patient characteristics, urinary tract infections (UTIs), other infectious events and all antibiotic prescriptions were recorded prospectively.Results: The patients' characteristics differed in the two centres in terms of age but not in diagnosis distribution. UTIs were recorded in 78 (24.2%) of the patients, ahead of pulmonary tract infections (n = 65; 20.2%). There was no difference in terms of CAUTI in the two catheter groups, even in subgroups with catheter treatment for 1 week or less. The patients with a diagnosed UTI required 3.5 more days of hospitalization than those without a UTI.Conclusion: CAUTIs were the most frequent healthcare-associated infections, slightly ahead of pulmonary tract infections. No advantages of the coated catheter could be found in this cohort of critically ill patients.

Background: urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment.Objective: the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons.Methods: a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis.Results: documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited.Conclusions: this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.

INTRODUCTION AND HYPOTHESIS:Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age. METHODS:Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life. The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95% CI were calculated. RESULTS:Five studies--all on the suburethral sling procedure in women-- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6%. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26%, mainly bladder perforation, bladder emptying disturbances, and de novo urge. CONCLUSION:The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.

Aim: The prevalence and severity of urinary incontinence (UI) increase with age and comorbidity. The benefits of pharmacotherapy for UI in the elderly are questionable. The aim of the present study was to systematically review the efficacy of pharmacological treatment for UI in the elderly and frail elderly.Methods: We searched PubMed, EMBASE, Cochrane library and Cinahl databases through October 2013 to identify prospective controlled trials that evaluated pharmacological treatment for UI in persons aged >= 65 years. Elderly persons living in nursing homes were regarded as frail elderly. Outcomes were urinary leakage, quality of life and adverse events.Results: We screened 1038 abstracts and assessed 309 full-text articles. We identified 13 trials of high or moderate quality; 11 evaluated anticholinergic drugs and two evaluated duloxetine. Oxybutynin, the only drug studied in the frail elderly population, had no effect on urinary leakage or quality of life in elderly with urgency UI (UUI). Seven trials evaluated the effects of darifenacin, fesoterodine, solifenacin, tolterodine or trospium. Urinary leakage decreased (standard mean difference: -0.24, 95% confidence interval -0.32-0.15), corresponding to a reduction of half a leakage per 24 h. Common side-effects of treatment were dry mouth and constipation. Data were insufficient for evaluation of the effect on quality of life or cognition. The evidence was insufficient to evaluate the effects of duloxetine. No eligible studies on mirabegron and estrogen were found.Conclusions: Anticholinergics have a small, but significant, effect on urinary leakage in older adults with UUI. Treatment with drugs for UUI in the frail elderly is not evidence based.

Previous research about school toilets is based on studies of children in elementary school. Thus, the aim of this study was to explore the experiences when using the school toilets reported by students aged 16-18 years. Qualitative interviews with 21 students were conducted and analyzed using content analysis. The data revealed that the toilets were considered insecure, dirty, and unpleasant. Additionally, students refrained from drinking during school hours and remained in constant movement or jumped up and down to withhold urine and stool. This was illustrated in the following categories: assessing the toilet environment, coping with the situation, and feeling exposed. Hence, there is an urgent need to improve the school toilet environment in order to respect the rights of all students to void or defecate when necessary, a process which will require involvement of students, teachers, and other school staff as well as the School Health Service.

Objective. The primary aim of this study was to compare the incidence of catheter- associated bacteriuria with a noble metal alloy-coated latex catheter or a non-coated silicone catheter in patients undergoing elective orthopaedic surgery with shortterm catheterization. Secondary objectives included identifying risk factors for bacteriuria and catheter-associated urinary tract symptoms. Material and methods. The study compared 217 patients randomized to and receiving a silicone catheter with 222 patients treated with a coated latex catheter. Before removal of the catheter a sample for urinary culture was obtained. Bacteriuria was defined as the growth of >= 100 000 cfu/ml. A logistic regression model was used to identify risk groups for bacteriuria. Patients were interviewed about urinary tract symptoms during and after catheterization. Results. The incidence of bacteriuria was 1.5% with the coated latex catheter and 5.5% with the silicone catheter (p = 0.027) after a mean period of 2 days' catheterization time. Female gender (odds ratio 6.02) and obesity (odds ratio 5.08) were significant risk factors for bacteriuria. A quarter of the patients reported at least one symptom from the urinary tract during and after catheterization. Most patients defined the symptoms as "yes, a little" and a few consulted a healthcare professional because of the symptoms. Conclusion. This study confirmed previous results that the noble metal alloy coating significantly reduces the risk of catheterassociated bacteriuria in short-term catheterization (1-3 days). Female gender and obesity were significant risk factors for developing bacteriuria, while the use of an open drainage system and insertion of the catheter on the ward were not.

OBJECTIVE:To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). DESIGN AND SETTING:Cross-sectional design, University hospital. SAMPLE:Forty-four patients awaiting prolapse surgery. METHODS:The dual-panel translation method followed by an evaluation of validity and reliability in prolapse patients. MAIN OUTCOME MEASURES:Construct, convergent and discriminant validity, reliability via test-retest and internal consistency. RESULTS:Item response rates were high (range 95.5-100%) for PFIQ-7 and PFDI-20. The corrected item-total correlations showed acceptable construct validity for PFIQ-7 (r=0.338-0.826) but low for PFDI-20 (r=0.116-0.581) and PISQ-12 (r=0.024-0.735). Acceptable convergent validity was found in all three instruments, with a negative correlation with the SF-12. There were no floor or ceiling effects in the three instruments. In the test-retest analysis, intraclass correlation coefficients were significant (r=0.888-0.943). Cronbach's α varied between 0.57 and 0.94. CONCLUSION:This is the first validated translation of the PFIQ-7, PFDI-20 and PISQ-12 in Swedish. All three instruments indicated acceptable psychometric properties.

Objective. To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Design and Setting. Cross-sectional design, University hospital. Sample. Forty-four patients awaiting prolapse surgery. Methods. The dual-panel translation method followed by an evaluation of validity and reliability in prolapse patients. Main Outcome Measures. Construct, convergent and discriminant validity, reliability via test–retest and internal consistency. Results. Item response rates were high (range 95.5–100%) for PFIQ-7 and PFDI-20. The corrected item–total correlations showed acceptable construct validity for PFIQ-7 ( r =0.338–0.826) but low for PFDI-20 ( r =0.116–0.581) and PISQ-12 ( r =0.024–0.735). Acceptable convergent validity was found in all three instruments, with a negative correlation with the SF-12. There were no floor or ceiling effects in the three instruments. In the test–retest analysis, intraclass correlation coefficients were significant ( r =0.888–0.943). Cronbach's α varied between 0.57 and 0.94. Conclusion. This is the first validated translation of the PFIQ-7, PFDI-20 and PISQ-12 in Swedish. All three instruments indicated acceptable psychometric properties.

Introduction Urinary incontinence is very common among older people, both men and women, and is often one of the causes of dependency on care in home or at institution (Nuotio et al 2003). Urinary tract symptoms are often mixed among the oldest old with urgency, difficulty in emptying urine or leakage (Stenzelius et al. 2006). However, few studies have identified the symptoms systematically and as a result of this, it is also difficult to have a constructive action plan, which both improves urgency, emptying and reduced leakages. There are signs in Sweden that the oldest and dependent in care are not being investigated or do not receive adequate treatment for their urinary tract symptoms and that women were less often investigated and treated compared to men (Swedish National board of Health and welfare (Socialstyrelsen), 2006). As this group of persons is known by the health care staff, it is also necessary to investigate why older persons do not get essential investigations and treatment. An important start is to gain information of the knowledge and attitudes of the health care staff.