Long-term experience with surgical treatment of selected patients with bladder pain syndrome/interstitial cystitis.

OBJECTIVE: The role of major surgery in patients with bladder pain syndrome/interstitial cystitis (BPS/IC) is not fully established. This report presents a single-institution experience with major surgery in patients with disabling BPS/IC where conservative treatment had failed. MATERIAL AND METHODS: Forty-one patients (34 women, seven men) with BPS/IC refractory to conservative treatment underwent major surgery from 1983 to 2004. Surgical approach was determined on a case-by-case basis. Postoperative pain and satisfaction were assessed by a questionnaire. RESULTS: Cystectomy was the primary procedure in five patients. The remaining 36 patients were primarily operated on with subtotal cystectomy and bladder augmentation (n = 16) or supravesical urinary diversion with intact bladder (n = 20). Thirteen of these patients were later operated on with cystectomy due to persisting pain 12 (6-146) months after the primary procedure. The questionnaire was answered by 38 of 41 patients after a median follow-up of 66 (6-238) months. In total, 28 patients (74%) were free of pain, and 26 patients (68%) were satisfied with the end result. There was no difference in reported pain between cystectomized and non-cystectomized patients. When comparing patients who reported pain at follow-up with those who did not report pain, preoperative length of symptoms was significantly increased, with 12.1 compared to 5.4 years (p = 0.02). CONCLUSIONS: Major surgery is associated with good symptom relief in strictly selected patients with disabling BPS/IC, where conservative treatment has failed. Extended preoperative duration of symptoms may be a predictor for persisting pain after major surgery for BPS/IC.

Uroflowmetry with simultaneous electromyography versus voiding video cystourethrography.

OBJECTIVES: Urethral dysfunction may lead to a deterioration of kidney function and be life-threatening. A thorough diagnosis of the pathophysiology is consequently vital to ensure the correct treatment is given. MATERIAL AND METHODS: In this study, 34 adult patients suspected of a urethral etiology giving rise to urinary retention, urgency or chronic lower urinary tract infections were investigated by uroflowmetry with simultaneous electromyography and voiding video cystourethrography. CONCLUSIONS: Both methods proved to be essential for an accurate assessment of the pathological state.

[Treatment of erectile dysfunction with penile implants]. / Behandling av ereksjonssvikt med penisimplantat.

BACKGROUND: Penile implants are the final step in the treatment of erectile dysfunction. The aim of this study was to evaluate patients treated with penile implants in our department. MATERIAL AND METHODS: From 1990 to 2002, 37 men with erectile dysfunction were treated with a three-component penile implant (AMS 700). In 2 patients the implant was removed; 2 patients were dead at the time of the study. The remaining group (n = 33) received a questionnaire concerning their penile implants, of whom 27 (82 %) responded. Mean observation time after surgery was 6 years. Mean age at surgery was 50 (27 - 68 years). RESULTS: Diabetes mellitus, trauma and venous insufficiency were the main reasons (68 %) for dysfunction in this patient group. Five patients had perioperative or early postoperative complications. Nineteen (51 %) were re-operated mainly because of dislocation (n = 5), perforation (n = 4) or mechanical failure (n = 4) of the implant. Twenty (74 %) patients were satisfied after surgery. There was no significant improvement in libido or in the relationship with partners. INTERPRETATION: Three out of four patients were pleased to have the penile implantation done despite the high reoperation rate.

Validation of a simple patient questionnaire to assist self-detection of overactive bladder. A study in general practice.

OBJECTIVE: To develop and validate a simple patient questionnaire for the detection of overactive bladder (OAB). DESIGN: An open, non-randomized multicentre study. SETTING: A pilot study (n = 133) was conducted to bring forward five questions from initially 14 questions, for detection of OAB. These five questions were subject to further validation in the main study (n =520). SUBJECTS: 531 adults responding to a newspaper advertisement regarding symptoms of OAB and patients seeing a physician for other reasons were attending 28 general practitioners. MAIN OUTCOME MEASURES: Agreement rate, sensitivity, and specificity. RESULTS: The agreement rate between the patients' own diagnosis based on the patient questionnaire, and the physicians' diagnosis based on medical history, urine analysis, and micturition chart, was 0.78 (kappa =0.89). Sensitivity and specificity were 0.98 and 0.90, respectively. CONCLUSION: The validated questionnaire may become a useful tool to decide whether a patient has overactive bladder. The questionnaire corresponds well with the physicians' diagnosis.

[Expandable penile implants in patients with erectile dysfunction]. / Penisimplantat ved ereksjonssvikt.

Modern medical treatment can restore normal sexual function in the majority of men with erectile dysfunction, but some men will not obtain an erection sufficient for sexual intercourse. In some of these men, with a strong desire to have an active sexual life including intercourse, it is possible to restore the function by the use of a penile implant. We describe the indications, the surgical procedure and the results with an expandable penile implant.

Sacral neuromodulation in Norway: clinical experience of the first three years.

We present our first three years' experience of sacral neromodulation as first line therapy in patients with a non-neurogenic refractory urge incontinence. In 53 patients, 45 women and 8 men with a mean age of 54 years (range 17-76 years), tested by subacute percutan nerve evaluation, 19 patients were declared as responders according to our programme. Fourteen patients, twelve women and two men with a mean age of 47 years (range 33-73 years), agreed to implantation of a neuroprosthesis (Medtronic Interstim Model 3031), which was placed in a subcutaneous buttock pocket in 12 patients. In the first two patients, the device was implanted subcutaneously corresponding to the lower quadrants of the abdominal wall. In two patients, the lead was repositioned from S:4 to S:3 six to twelve months after the primary implantation. In one woman with sensory urgency, the neuroprosthesis was removed six months after it was implanted because of failure. The patients were followed every six months using voiding diary, uroflowmetry, residual urine and cystometry. Eight patients reported total continence, and five declared >50% improvement. One woman has chronic bacteriuria and intermittently symptomatic urinary tract infection, which reduce the response to the chronic sacral nerve stimulation. Because of residual urine, four women are following an individual self-catheterisation programme. In conclusion, we have documented that sacral neuromodulation is an effective and safe procedure in patients with refractory urge incontinence depending on detrusor overactivity. We confirm the clinical results reported by other centres with long experience of sacral neuromodulation.