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T Davidsson

Publications and source records attributed to T Davidsson.

At least 19 recordsLinked to original sources
PubMed2003

Continent urinary tract reconstruction - the Lund experience.

UNLABELLED: The Department of Urology in Lund, Sweden, has a long association with innovations in reconstructive urology. The authors from that department describe their experience over a long period with orthotopic bladder substitution and continent cutaneous urinary diversion. They conclude that continent urinary tract reconstruction is associated with a high incidence of early and late complications. They also found that for storage and emptying, their Lundiana pouch was superior to the Goldwasser neobladder. OBJECTIVE: To assess the early and late complications and functional results in patients undergoing continent reconstruction of the urinary tract, i.e. orthotopic bladder substitution (OBS) or continent cutaneous diversion (CCD). PATIENTS AND METHODS: The medical records of all patients undergoing OBS (Goldwasser technique) or CCD ('Lundiana' technique) for malignant or benign disease during 1987-1999 and followed to December 2001 were reviewed. There were 67 patients with neobladders, 77 with a Lundiana pouch who had undergone radical cystectomy and 22 with a Lundiana pouch operated for benign disorders. RESULTS: Early complications requiring reoperation occurred in 12% of the cystectomy group, with no difference with type of reconstruction, and in 10% with benign diseases. Four patients (3%) undergoing radical cystectomy died from early cardiovascular complications, two after surgery for intra-abdominal complications. Intestinally related complications and wound dehiscence requiring re-operation occurred in nine and six patients, respectively. The incidence of late complications requiring open surgery was 22% and 23% after cystectomy with OBS and CCD, respectively. The value in patients with benign diseases undergoing CCD was also 23%. Stone formation in the pouch was common, occurring in 12% in patients with OBS and in 10% after CCD. The pouch perforated or ruptured in four patients. The incidence of uretero-intestinal stricture using the Le Duc technique was 2.4% and renal function was well preserved. The incidence of revisional surgery of the Lundiana pouch outlet for incontinence was low and all patients but four were continent. The functional outcome in patients with OBS was less good; some needed pouch augmentation or an artificial urinary sphincter. Most patients used incontinence products and many needed clean intermittent self-catheterization. CONCLUSION: Continent urinary tract reconstruction is associated with a high incidence of early and late complications. For storage and emptying, the CCD Lundiana pouch is superior to the OBS of Goldwasser.

Aged↗
PubMed2003

[Bladder cancer and the sentinel node concept].

PURPOSE: Lymph node status is one of the most important prognostic factors in muscle-invasive bladder cancer. The extent of lymphadenectomy performed in conjunction with cystectomy and the question as to whether this is a staging or therapeutic intervention are matters of discussion. The aim of this study was to evaluate the sentinel node (SN) concept and to correlate findings with tumour status in excised regional lymph nodes. MATERIAL AND METHOD: 26 patients scheduled for cystectomy were investigated with preoperative lymphoscintigraphy, peroperative dye detection (Patent Blue) and dynamic lymphoscintigraphy (Nanocoll or Albures 50 MBq/ml). The substances were injected adjacent to the tumour in the detrusor muscle. RESULTS: Sentinel nodes were detected in 21 of the 26 of the investigated patients. 7/21 SN were located outside the obturator fossa. Of the eight patients with lymph node metastasis, five displayed metastasis in lymph nodes outside the obturator fossa. There was one false negative SN in a patient with multifocal tumour, while in the other seven patients with lymph node metastasis, these were detected in the SN. CONCLUSION: Sentinel node detection is possible in most cases of bladder cancer scheduled for cystectomy. The significance of utilizing this method to detect lymph node metastasis outside the obturator fossa warrants further investigation.

Cystectomy↗
PubMed2003

[Transitional cell carcinoma of the prostate in cystoprostatectomy specimens].

PURPOSE: Transitional cell carcinoma (TCC) of the prostate/prostatic urethra is a risk factor for urethral recurrence after radical cystoprostatectomy for TCC. Using conventional sectioning techniques, prostate involvement (prostatic urethra, acini, ducts and/or stroma) has been detected in a range of 10-20% of the patients, whereas transversal whole mount sectioning has revealed 43 % prostate involvement in two reported series. Due to different mechanisms of prostate involvement (intraurethral, extravesical and direct overgrowth into the prostatic stroma), preoperative transurethral biopsies of the prostate might not accurately determine such involvement. In this study we examine the prostate using a longitudinal whole mount sectioning technique, correlate TCC of the prostate with the characteristics of the bladder tumour and, thus, validate the preoperative transurethral resection biopsies. MATERIAL AND METHODS: Patients scheduled for cystoprostatectomy or cystoprostatourethrectomy were investigated by preoperative resection biopsies from the prostatic urethra and mapping of the bladder. The cystectomy specimen was fixated with the bladder filled with formalin, and the prostate and bladder neck examined using longitudinal whole mount sectioning. RESULTS: In 13 of the 43 (30%), patients TCC was identified in the prostate. Of these 13 patients, 9 had been identified in the preoperative resection biopsies from the prostatic urethra. Of the patients with prostatic involvement, 46% had carcinoma in situ (Cis) in the bladder neck/trigone and 38% had multifocal Cis in the bladder. Comparing this to the group of patients without prostatic involvement, the respectively figures are 20% and 23%. A tumour in the trigone, either invasive or Cis, was detected in 5/13 patients with prostatic involvement as compared to one patient (3%) without TCC of the prostate. Multiple bladder tumours were more common in patients with prostatic involvement and were larger (3.2 cm compared to 2.2 cm). CONCLUSIONS: Preoperative resection biopsies from the prostatic urethra do not always detect TCC in the prostate. Cis in the bladder neck/trigone or multifocal and multiple bladder tumours could be risk factors for prostate involvement of TCC.

Biopsy↗
PubMed2002

The quality of life in men after radical cystectomy with a continent cutaneous diversion or orthotopic bladder substitution: is there a difference?

OBJECTIVE: To compare the quality of life (QoL) in men after radical cystectomy who had either a continent cutaneous diversion or orthotopic bladder substitution. PATIENTS AND METHODS: Eighty men with at least 6 months of follow-up and with no signs of recurrent disease after radical cystectomy for bladder carcinoma, and who had either a continent cutaneous diversion or orthotopic bladder substitution, were sent two types of questionnaire, the Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-Bl) and the Hospital Anxiety and Depression Scale (HADS), to determine their QoL. RESULTS: The FACT-Bl and HADS questionnaires were returned by 90% and 71% of the patients, respectively (P < 0.05). In the replies to the generic version of FACT-Bl there were no differences between the groups in any domain, the scores being high in all. In questions covering intestinal, urinary and sexual items, patients with continent diversion had less trouble controlling urine (P < 0.0001), had to empty less often (P < 0.001), and had fewer symptoms when emptying (P < 0.05). Patients with neobladders had a better appreciation of appearance and better preserved erectile function (both P < 0.05). In the answers to the HADS, the mean scores were low (within the normal ranges) and did not differ between the groups. CONCLUSION: Using two instruments tested for validity and reliability, there were no differences between patients with continent diversion and those with orthotopic substitution.

Aged↗
PubMed2000

Urinary diversion and bladder substitution in patients with bladder cancer.

For the majority of patients with invasive bladder carcinoma, radical cystectomy remains the gold standard of care. As a result the twentieth century has seen the continuous development of methods for reconstructing the urinary tract. Two decades ago the ileal conduit was by far the most commonly used method, whereas today methods geared toward patient continence are first choices in most centers. Some of these methods are unquestionably more complex than the ileal conduit, yet whether they actually yield uniformly improved quality of life is the cause of much debate. Many different variables play a role in determining the best type of reconstruction for an individual bladder cancer patient. This review analyzes the different factors that must be considered to obtain an optimal match between patient and reconstructive method.

Journal Article↗
PubMed2000

Permeability of intestinal mucosa from urinary reservoirs in man and rat.

OBJECTIVE: To evaluate the barrier properties of intestinal mucosa chronically exposed to urine and to evaluate possible differences between ileal and colonic segments used in the reconstruction of the urinary tract. MATERIALS AND METHODS: Mucosal specimens from patients with continent reservoirs with an abdominal stoma, or orthotopic neobladders constructed from colonic segments, were obtained at revisional surgery. Control segments were obtained during right-sided hemicolectomy. In addition, ileal and colonic segments from enterocystoplasties in rats were assessed. The mucosa-to-serosa passage of marker molecules, i.e. (14)C-mannitol, (3)H-glucose, fluorescein isothiocyanate-dextran 4400 and ovalbumin, was measured using modified Ussing diffusion chambers. RESULTS: In man, there were no permeability differences between segments exposed to urine and control segments for any of the marker molecules. In rats, there was less passage of markers in ileal and colonic transplanted segments than in intestinal segments from sham-operated animals. CONCLUSIONS: Intestinal mucosa that has been in chronic contact with urine maintains its barrier function; in the rat model the permeability was even decreased. In addition, there were no detectable differences between ileal and colonic segments in this model.

Adult↗
PubMed1999

Sprouting of bladder nerves into cystoplastic cecal segment in the rat.

Incorporation of bowel into the bladder (enterocystoplasty) has been widely used to increase bladder capacity. It has been reported by others that the response of smooth muscle from the cystoplastic segment of the intestine shifts from that of the intestine (relaxation to alpha-agonists and ATP) to that of the bladder (contraction to alpha-agonists and ATP). This suggests a functional integration of the intestinal muscle into the bladder; the mechanisms are unknown. The aims of the present study were (1) to elucidate if there are signs of bladder nerves sprouting across the anastomosis into the intestinal segment, and (2) to study what happens with the intrinsic innervation of the intestinal segment. As a model, we used cecocystoplasty in rats. The bladder was opened and a patch of cecum with intact vascular supply was anastomosed to the bladder. After two to 11 months the rats were sacrificed and the bladders mounted as wholemounts and stained for acetylcholinesterase-containing nerves, or embedded in paraffin for histology. A pronounced degeneration of the myenteric plexus was found in the cecal segments. In some areas, this had proceeded to the extent that the ganglia were isolated ovoid lumps of cells with no apparent connection to other ganglia. Areas lacking ganglia and nerve trunks but still with muscle could be found in all specimens. Abundant axon bundles were demonstrated sprouting from the cut bladder nerves close to the anastomosis. The bundles spread out in a fan-like pattern or were organized as fewer thicker nerves. There were many nerve bundles entering the cecal segment where they branched and the diameter decreased till they no longer became visible. Some nerves reached surviving lumps of myenteric ganglion cells. The results show that the bladder nerves sprout into the anastomosed cecal segment. It is reasonable to assume that these nerves are responsible for the changes in receptor pharmacological properties of the cecal smooth muscle towards that of bladder muscle.

Animals↗
PubMed1999

Ureteric obstruction due to kinking of the reservoir inlet in a continent urinary reservoir.

We report a case of symptomatic intermittent upper tract obstruction in a continent urinary reservoir. The ureters were of great intraperitoneal length and were positioned in front of the mesenterium, resulting in a mobile reservoir. Only the retroperitoneal part of the ureters was dilated due to kinking in the peritoneal passage. After the ureters were shortened and reanastomosed retroperitoneally, the repeated episodes of abdominal pain and discomfort disappeared..

Adolescent↗
PubMed1997

Metabolic alterations at different levels of renal function following continent urinary diversion through colonic segments.

PURPOSE: We evaluated the influence of renal function on electrolyte and acid-base homeostasis in patients with colonic reservoirs for urine and the ability of these patients to handle an acute acid load. MATERIALS AND METHODS: The 19 patients studied were divided into 2 groups according to preservation of the glomerular filtration rate at last followup: group 1-well preserved glomerular filtration rate (mean 100 ml. per minute per 1.73 m.2) with an average followup of 8.5 years and group 2-slight to moderate decrease in glomerular filtration rate (mean 55 ml. per minute per 1.73 m.2) with a mean followup of 10.5 years. Renal tubular function was evaluated by urinary levels of protein alpha 1-microglobulin. Baseline serum and urine samples were analyzed for metabolic parameters, and baseline arterial blood gas was measured. Immediately thereafter ammonium chloride loading was performed. RESULTS: Some difference in acid-base homeostasis was found with slight hyperchloremic metabolic acidosis noted in 4 patients in group 2. Moreover, calcium homeostasis was influenced, with lower levels of ionized calcium noted in group 2. However, no difference was found in the ability of the patients in both groups to handle an acute acid challenge. CONCLUSIONS: Patients with a glomerular filtration rate of approximately 55 ml. per minute per 1.73 m.2 have sufficient renal function to compensate for the chronic endogenous acid load noted after urinary diversion and they can also handle an acute acid load adequately. Further studies are necessary to evaluate the long-term effects of a chronic endogenous acid load, for example on bone metabolism, in patients with impaired renal function after urinary intestinal diversion.

Acid-Base Equilibrium↗
PubMed1996

Detubularized right colonic reservoir with intussuscepted ileal nipple valve or stapled ileal ("Lundiana") outlet. Clinical and urodynamic results in a prospective randomized study.

In a prospective randomized study, patients undergoing cystectomy and continent urinary diversion by means of a detubularized right colonic reservoir were randomized to one of two types of outlet: either an intussuscepted ileal nipple valve (n = 15) or a stapled ileal ("Lundiana") outlet (n = 15). There were no early complications from the reconstruction. Subsequently, one ileal nipple outlet required revision because of progressive catheterization difficulties. In the Lundiana group, perforation of the reservoir occurred in one case and a narrow stomal opening was revised in local anesthesia in two cases. Urodynamic assessment revealed similar pressures at rest for the two outlets. At stress (concomitant with reservoir contraction), there was a distinct increase in outlet pressure in the nipple valves, but this was rarely encountered in the Lundiana group. Questionnaires showed episodes of urinary leakage to be more common in the Lundiana group, whereas the reverse applied to catheterization difficulties. In both groups, however, the great majority of patients were satisfied or very satisfied with the function of the urinary tract.

Adult↗
PubMed1996

Mucosal permeability of ileal and colonic reservoirs for urine.

OBJECTIVES: To evaluate the intestinal mucosal permeability in continent reservoirs for urine. PATIENTS AND METHODS: The mucosal permeability in continent urinary reservoirs, constructed either from an ileal or a colonic segment (six patients each), was assessed by analysing serial samples of plasma, after instilling the reservoir with 51Cr-ethylene diaminetetra-acetic acid (51Cr-EDTA), and serum, after instillation with polyethylene glycol (PEG 400). RESULTS: There was no or negligible permeation of 51Cr-EDTA and PEG 400 in either type of reservoir, as there was no significant increase of the markers in plasma and serum, respectively. CONCLUSION: The intestinal barrier to medium-sized hydrophilic molecules seems intact in continent urinary reservoirs. The lack of significant permeation of 51Cr-EDTA confirms the usefulness of a single injection of 51Cr-EDTA for the determination of glomerular filtration rate in patients with intestinal urinary diversion.

Colon↗
PubMed1996

Morphologic changes in intestinal mucosa with urinary contact--effects of urine or disuse?

PURPOSE: To evaluate the morphological changes induced in bypassed ileal and colonic segments and the influence of the urine on the mucosal histology. MATERIALS AND METHODS: In a rat model, an isolated ileocolonic segment was used for construction of an ileocolocystoplasty or an exteriorized blind loop. Sham-operated animals were used for control. RESULTS: In ileal mucosa, villi and microvilli were better preserved when exposed to urine than when deprived of contact with luminal content. Numerical reduction of microvilli was found in colonic mucosa deprived of luminal content. In colonic mucosa exposed to urine some areas were denuded of microvilli and showed blebs. Findings of intact tight junctions in all specimens implied that an important morphological requirement of maintained epithelial barrier function is present in mucosa deprived of normal luminal stimulation and also after contact with urine. The intracellular ultrastructural changes in both colon and ileum were similar in the 2 groups. However, there were more solitary ribosomes lying free in the mucosa exposed to urine, indicating depressed or arrested protein synthesis. CONCLUSIONS: Mucosa in contact with urine seems to maintain surface characteristics better than mucosa deprived of luminal stimulation, indicating that factors present in the urine may be important for the epithelial cell physiology. Certain intracellular changes were found more often in mucosa exposed to urine, but there were no major differences. The changes noticed may indicate enterocyte adaptation to a new physiologic environment.

Animals↗
PubMed1995

Long-term metabolic effects of urinary diversion on skeletal bone: histomorphometric and mineralogic analysis.

OBJECTIVES: To evaluate the long-term influence of different types of intestinal urinary diversion on skeletal bone and its mineral content. METHODS: Densitometry was used to estimate bone mineral content, and bone biopsies were analyzed with histomorphometric technique. The study comprised 20 patients with conduit urinary diversion and 19 with cecal continent reservoir, all followed up for more than 5 years, with normal or near-normal renal function. RESULTS: Bone mineral content did not differ significantly between the patients with cecal continent urinary reservoir and those with conduit diversion or between these groups and a reference group. At the cellular level, the histomorphometric analysis revealed no defective bone mineralization or increased bone resorption in either group of patients. The trabecular bone volume was greater than normal in the reservoir group, but not in the conduit group. The appositional rate was significantly below normal in both groups of patients, but did not differ between conduit and reservoir patients. CONCLUSIONS: Subtle changes in electrolytes and acid-base homeostasis identified in adults with intestinal segments incorporated in the urinary tract and with largely normal renal function do not seem to influence bone mineralization in the long term. At the cellular level, a lower than normal appositional rate was found in the patients with conduit or continent urinary diversion. In the latter group, this finding, together with increased trabecular bone volume, may indicate a decrease of bone turnover.

Acid-Base Equilibrium↗
PubMed1995

Long-term metabolic and nutritional effects of urinary diversion.

OBJECTIVES: To evaluate the long-term metabolic and nutritional consequences of interposing intestinal segments in the urinary tract. METHODS: Comprehensive analyses of blood and urine were performed in 20 patients with conduit urinary diversion and in 19 with continent cecal reservoir for urine, all with normal or near-normal renal function. The mean follow-up time was 15 years in the conduit group and 9 years in the reservoir group. RESULTS: In both patient groups, arterial blood gas analysis revealed a tendency to metabolic acidosis with respiratory compensation. Although no hyperchloremia was found in either group, the mean value of serum chloride was significantly higher (P < 0.05) in the reservoir group than in the conduit group. The calciotropic factors, plasma lipids, lipoproteins, and liver function values were normal in both groups. Serum vitamin B12 levels were subnormal in 3 conduit and 2 reservoir patients, but other studied variables of intestinal absorption were within normal limits. Conduits utilizing colonic segments showed calcium excretion on the same level as in reservoirs, which was significantly higher than in conduits made from ileal segments. CONCLUSIONS: Except for increased risk of vitamin B12 deficiency, no major adverse metabolic or nutritional effects of conduit or continent urinary diversion were found at long-term observation in patients with well-preserved renal function. Lifelong surveillance of vitamin B12 levels is necessary in these patients.

Acid-Base Equilibrium↗
PubMed1994

Absorption of sodium and chloride in continent reservoirs for urine: comparison of ileal and colonic reservoirs.

The absorptive capacity of urinary reservoir mucosa was studied by measuring the fractions of 22sodium and 36chloride absorbed after instillation into reservoirs constructed from an ileal or a colonic segment. The absorption of 22sodium did not differ between the 2 reservoir types but absorption of 36chloride was greater in the colonic reservoirs. The levels of chloride in serum were significantly higher in patients with a colonic than in those with an ileal reservoir. In the ileal reservoirs the absorptive capacity was greater for 22sodium than for 36chloride.

Absorption↗
PubMed1992

Tapering of intussuscepted ileal nipple valve or ileocecal valve to correct secondary incontinence in patients with urinary reservoir.

Malfunction of the outlet mechanism, that is leakage of urine or difficulty in catheterization, has been the main problem in the evolution of continent urinary reservoirs. Urinary leakage in 3 patients with a right colonic reservoir (2 with an intussuscepted ileal nipple valve and 1 with a plicated ileal segment as a continence mechanism) was managed with tapered narrowing of the nipple valve and the ileocecal valve, respectively, using stapling techniques. Continence was thereby reestablished without impeding catheterization. Tapering is easy to perform and, when applicable, can obviate the need for a major surgical procedure.

Adult↗
PubMed1991

Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement.

Urodynamic evaluation was performed in 13 men 4 to 18 months after cystoprostatectomy and bladder replacement using a detubularized right colonic segment. All patients are continent by day and only 3 are incontinent during the night to a degree that necessitates use of a condom catheter. Two patients awaken every 2 to 3 hours to void and the remainder have nocturia comparable to normal men of their age. The residual volume was 0 to 70 ml. The urethral closure pressure was normal, and in 3 patients studied preoperatively and postoperatively no significant change was observed other than shortening of the profile length. Maximal flow rates were normal although the pattern was intermittent. In 2 patients no cystoplasty contractions were recorded and in all but 2 patients the amplitude of the contractions was less than 40 cm. water. Simultaneous bladder and urethral pressure recordings during bladder filling demonstrated no change in urethral pressure in 10 patients. Although creation of a reservoir with a low pressure and careful preservation of the infraprostatic urethra are important for continence in these patients, we believe that the absence of normal sacral route reflexes after cystoprostatectomy is an important contributing cause to nocturnal incontinence.

Colon↗