ABSTRACT
OBJECTIVE: Pelvic floor muscle training effectively treats female stress urinary incontinence. However, data on long-term efficacy and adherence are sparse. Our aims were to assess current lower urinary tract symptoms and exercise adherence 15 years after ending organized training. METHODS: Originally, 52 women with urodynamic stress urinary incontinence were randomly assigned to home or intensive exercise. After 6 months, 60% in the intensive group were almost or completely continent, compared with 17% in the home group. Fifteen years later, all original study subjects were invited to complete a postal questionnaire assessing urinary symptoms (using validated outcome tools) and current pelvic floor muscle training. RESULTS: Response rate was 90.4%. There were no differences in any urinary outcomes or satisfaction between the 2 study groups as a whole or when restricted to those without intervening stress urinary incontinence surgery. One half of both groups had stress urinary incontinence surgery during the 15-year follow-up period. Twenty-eight percent performed pelvic floor muscle training at least weekly; this rate did not differ by original group assignment or operated status. More operated women reported severe incontinence (P = .03) and leakage that interfered with daily life (P = .04) than did nonoperated women. There were no other differences between operated and nonoperated women. CONCLUSION: The marked benefit of intensive pelvic floor muscle training seen short-term was not maintained 15 years later. Long-term adherence to training is low. Urinary symptoms were equally common in both operated and nonoperated women. Further studies are needed to understand factors associated with long-term effectiveness of stress urinary incontinence treatments.
Subject(s)
Exercise Therapy/methods , Muscle, Smooth/physiology , Pelvic Floor , Quality of Life , Urinary Incontinence, Stress/rehabilitation , Adult , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Muscle Contraction/physiology , Patient Compliance , Probability , Randomized Controlled Trials as Topic , Risk Assessment , Severity of Illness Index , Surveys and Questionnaires , Time Factors , Treatment Outcome , Urinary Incontinence, Stress/diagnosis , UrodynamicsABSTRACT
BACKGROUND: Penile cancer is a rare malignancy in Norway with about 40 new cases each year. MATERIAL AND METHODS: An overview on diagnosis and treatment of penile cancer is given and the guidelines from the European Association of Urology are presented. RESULTS: Phimosis and poor genital hygiene are pre-disposing conditions for penile cancer. Condylomata acuminatum and leukoplakia should be regarded as premalignant lesions. The superficial form of penile cancer should be treated by laser, surgery or radiotherapy. When the cancer infiltrates into corpus cavernosum or corpus spongiosum, or the tumour displays a poorly differentiated histology, a partial or total amputation of the penis has to be performed. Inguinal lymphadenectomy is recommended in patients presenting with a tumour > or = pT2 or if the histology reveals a moderately or poorly differentiated cancer. Five-year survival rate is about 80% for patients with localised tumour, and about 50% in patients with regional lymph node metastasis. INTERPRETATION: We recommend that the treatment of penile cancer is performed in the regional hospitals.