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Spångberg, Anders
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Marklund-Bau, H., Spångberg, A. & Edéll-Gustafsson, U. (2015). Sleep and partner-specific quality of life in partners of men with lower urinary tract symptoms compared with partners of men from the general population.. Scandinavian journal of urology, 49(4), 321-328
Open this publication in new window or tab >>Sleep and partner-specific quality of life in partners of men with lower urinary tract symptoms compared with partners of men from the general population.
2015 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, no 4, p. 321-328Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to examine differences between partners of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and partners of men from the population regarding sleep and two aspects of quality of life, partner-specific quality of life and health-related quality of life (HRQoL), and to identify factors related to the partner-specific quality of life and the parameter sleep efficiency. Materials and methods. The design was descriptive and comparative. The subjects were partners of men with LUTS suggestive of BPO (n = 126) and partners of randomly selected men from the general population (n = 131). Self-administered questionnaires about demography, comorbidity, sleep, sexuality, partner-specific quality of life and HRQoL were used. Results. Partners of men with LUTS suggestive of BPO were significantly more affected in all variables measuring partner-specific quality of life compared with partners from the population. The most impaired aspects were compassion and worry about an operation or cancer. In logistic regression, the only explanatory factors were having a partner belonging to the LUTS group for impaired partner-specific quality of life and having a bed partner for high sleep efficiency. There were no significant differences between the two groups regarding the quantity and quality of sleep or the HRQoL. Conclusions. The partner-specific quality of life was impaired in partners of men with LUTS suggestive of BPO. Sleep and HRQoL did not differ between partners of men with LUTS and partners from the population.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-116341 (URN)10.3109/21681805.2014.990052 (DOI)000359170200010 ()25515951 (PubMedID)
Available from: 2015-03-26 Created: 2015-03-26 Last updated: 2017-12-04
Bill-Axelson, A., Holmberg, L., Garmo, H., Rider, J. R., Taari, K., Busch, C., . . . Johansson, J.-E. (2014). Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer. New England Journal of Medicine, 370(10), 932-942
Open this publication in new window or tab >>Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer
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2014 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, no 10, p. 932-942Article in journal (Refereed) Published
Abstract [en]

BackgroundRadical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. MethodsBetween 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. ResultsDuring 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04). ConclusionsExtended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.) The randomized Swedish trial of prostatectomy versus watchful waiting in disease detected mainly clinically (not by PSA screening) continues to show a benefit for early prostatectomy. The number of men younger than 65 needed to treat to prevent one death is now four. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of prostate-specific antigen (PSA) testing, showed a survival benefit of radical prostatectomy as compared with observation at 15 years of follow-up.(1) By contrast, the Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of PSA testing, showed that radical prostatectomy did not significantly reduce prostate cancer-specific or overall mortality after 12 years.(2) PSA screening profoundly changes the clinical domain of study. Among other considerations, the substantial additional lead time ...

Place, publisher, year, edition, pages
Massachusetts Medical Society, 2014
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-106869 (URN)10.1056/NEJMoa1311593 (DOI)000332309800010 ()
Available from: 2014-05-28 Created: 2014-05-23 Last updated: 2017-12-05
Spångberg, A. & Dahlgren, H. (2013). [Benign prostatic hyperplasia with bladder outflow obstruction. A systematic review].. Läkartidningen, 110(13-14), 682-685
Open this publication in new window or tab >>[Benign prostatic hyperplasia with bladder outflow obstruction. A systematic review].
2013 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 13-14, p. 682-685Article in journal (Refereed) Published
Abstract [sv]

Godartad prostataförstoring med avflödeshinder är en vanlig sjukdom. Försäljningen av ­l­äkemedel i Sverige motsvarar kontinuerlig behandling av 100 000 män. Antalet operationer per år är 4 500.

SBU publicerade 2011 en systematisk litteraturgranskning av området.

En stor del av handläggningen kan ske i primärvården. Patienterna behandlas i regel på sannolikhetsdiagnos och endast ett fåtal gör tryck–flödes­undersökning som kan ge säker diagnos.

Vid lindriga besvär krävs ingen behandling. Vid måttliga–­svåra besvär står valet mellan en mindre effektiv och lindrig behandling, läkemedel, och en besvärligare men också mycket effektivare kirurgisk behandling.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-116689 (URN)23634622 (PubMedID)
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2017-12-04
Bill-Axelson, A., Holmberg, L., Ruutu, M., Garmo, H., Stark, J. R., Busch, C., . . . Johansson, J.-E. (2011). Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer. NEW ENGLAND JOURNAL OF MEDICINE, 364(18), 1708-1717
Open this publication in new window or tab >>Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer
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2011 (English)In: NEW ENGLAND JOURNAL OF MEDICINE, ISSN 0028-4793, Vol. 364, no 18, p. 1708-1717Article in journal (Refereed) Published
Abstract [en]

BACKGROUND In 2008, we reported that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, we now report estimated 15-year results. METHODS From October 1989 through February 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy. Follow-up was complete through December 2009, with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death. Relative risks, with 95% confidence intervals, were estimated with the use of a Cox proportional-hazards model. RESULTS During a median of 12.8 years, 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died (P=0.007). In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting, death was due to prostate cancer. This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6% and 20.7%, respectively (a difference of 6.1 percentage points; 95% confidence interval [CI], 0.2 to 12.0), and a relative risk with surgery of 0.62 (95% CI, 0.44 to 0.87; P=0.01). The survival benefit was similar before and after 9 years of follow-up, was observed also among men with low-risk prostate cancer, and was confined to men younger than 65 years of age. The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age. Among men who underwent radical prostatectomy, those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth (relative risk, 6.9; 95% CI, 2.6 to 18.4). CONCLUSIONS Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment.

Place, publisher, year, edition, pages
Massachusetts Medical Society, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68215 (URN)10.1056/NEJMoa1011967 (DOI)000290219800007 ()
Available from: 2011-05-13 Created: 2011-05-13 Last updated: 2011-05-13
Marklund, H., Spångberg, A. & Edéll-Gustafsson, U. (2010). Sleep and health-related quality of life in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the general population and patients with inguinal hernia. Scandinavian Journal of Urology and Nephrology, 44(5), 304-314
Open this publication in new window or tab >>Sleep and health-related quality of life in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the general population and patients with inguinal hernia
2010 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 5, p. 304-314Article in journal (Refereed) Published
Abstract [en]

Abstract Objective. To determine whether there are differences in the quantity and quality of sleep, including sleep efficiency and insomnia, and health-related quality of life (HRQoL) between patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO), men from the general population and patients with inguinal hernia. Material and methods. The designs were descriptive and comparative. The groups consisted of 239 patients aged 45-80 years who were referred to urological departments with LUTS suggestive of benign prostatic obstruction. The comparison groups consisted of 213 randomly selected men from the general population, stratified according to age and geographical region, and 200 patients with inguinal hernia. The setting was one university and two general hospitals. The method was self-administered questionnaires about demography, comorbidity, sleep and health-related quality of life. Further, patients with LUTS answered questions about urinary symptoms and disease-specific quality of life. Results. The prevalence of insomnia was 40%, 26% and 19% and the prevalence of sleep efficiency < 85% was 49%, 38.5% and 31% in the LUTS, general population and hernia groups, respectively. The median number of nocturnal micturitions was 2, 1 and 1. In the LUTS group (n = 216), 47% had IPSS 8-19 and 44% had >/= 20 points. The HRQoL was significantly impaired in patients with LUTS compared with one or both of the comparison groups (p values < 0.05). Conclusions. Patients with LUTS suggestive of BPO had significantly impaired sleep, a higher prevalence of insomnia and significantly impaired HRQoL compared with one or both of the comparison groups.

Place, publisher, year, edition, pages
Informa Healthcare, 2010
Keywords
Benign prostatic hyperplasia, Benign prostatic obstruction, Disease specific quality of life, Health related quality of life, Inguinal hernia, Insomnia, Lower urinary tract symptoms, Population, Sleep disorders, Sleep quality
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-15944 (URN)10.3109/00365599.2010.488246 (DOI)000283129200005 ()20476852 (PubMedID)
Available from: 2008-12-17 Created: 2008-12-17 Last updated: 2017-12-14Bibliographically approved
Marklund-Bau, H., Edéll-Gustafsson, U. & Spångberg, A. (2008). A Swedish version of a quality of life questionnaire for partners of men with symptoms suggestive of benign prostatic obstruction. Scandinavian Journal of Urology and Nephrology, 42(2), 126-131
Open this publication in new window or tab >>A Swedish version of a quality of life questionnaire for partners of men with symptoms suggestive of benign prostatic obstruction
2008 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 42, no 2, p. 126-131Article in journal (Refereed) Published
Abstract [en]

Objectives: Little is known about the quality of life experienced by the partners of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). The aims of this study were to translate a specific quality of life questionnaire for partners to patients with benign prostatic enlargement (BPE)/BPO to swedish and to test its reliability and responsiveness. A secondary aim was to evaluate the impact the patients' urinary symptoms have on their partners' specific quality of life.

Material and methods: This study was conducted using two groups: a reliability partner group; and a responsiveness/evaluation partner group. Both groups consisted of the partners of patients on the waiting list for transurethral resection of the prostate (TURP). The reliability of the quality of life questionnaire for the partners of men with BPE/BPO was tested in 51 partners, with a test-retest interval of 5 weeks. The partners' specific quality of life and the responsiveness of the questionnaire were evaluated in 51 partners by administering the questionnaire before and 3 months after the patient's TURP.

Results: At the test-retest, the Spearman's rank correlation coefficient for each question varied between 0.59 and 0.86 and Cronbach's was 0.80. Partners were affected by the patients' BPO symptoms. Compassion, worry about cancer and worry about an operation were the aspects of the specific quality of life that affected most partners (92%, 77% and 65%, respectively), whereas effects on spare time and household activities affected fewer partners: 35% and 24%, respectively. The specific quality of life among partners improved significantly after the patient's TURP.

Conclusions: The Swedish version of a partner-specific quality of life questionnaire for men with LUTS suggestive of BPE/BPO had an acceptable reliability and responsiveness. Partners are affected by the patients' symptoms, and it is emotional rather than practical aspects which most affect them.

Place, publisher, year, edition, pages
Taylor & Francis, 2008
Keywords
Benign prostatic enlargement; benign prostatic obstruction; lower urinary tract symptoms; transurethral resection of the prostate; partner; quality of life; questionnaire; urinary symptoms
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-15943 (URN)10.1080/00365590701725698 (DOI)
Available from: 2008-12-17 Created: 2008-12-17 Last updated: 2017-12-14Bibliographically approved
Bill-Axelson, A., Holmberg, L., Filen, F., Ruutu, M., Garmo, H., Busch, C., . . . Johansson, J.-E. (2008). Radical prostatectomy versus watchful waiting in localized prostate cancer: The Scandinavian prostate cancer group-4 randomized trial. Journal of the National Cancer Institute, 100(16), 1144-1154
Open this publication in new window or tab >>Radical prostatectomy versus watchful waiting in localized prostate cancer: The Scandinavian prostate cancer group-4 randomized trial
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2008 (English)In: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 100, no 16, p. 1144-1154Article in journal (Refereed) Published
Abstract [en]

Background: The benefit of radical prostatectomy in patients with early prostate cancer has been assessed in only one randomized trial. In 2005, we reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. We now report results after 3 more years of follow-up. Methods: From October 1, 1989, through February 28, 1999, 695 men with clinically localized prostate cancer were randomly assigned to radical prostatectomy (n = 347) or watchful waiting (n = 348). Follow-up was complete through December 31, 2006, with histopathologic review and blinded evaluation of causes of death. Relative risks (RRs) were estimated using the Cox proportional hazards model. Statistical tests were two-sided. Results: During a median of 10.8 years of follow-up (range = 3 weeks to 17.2 years), 137 men in the surgery group and 156 in the watchful waiting group died (P =. 09). For 47 of the 347 men (13.5%) who were randomly assigned to surgery and 68 of the 348 men (19.5%) who were not, death was due to prostate cancer. The difference in cumulative incidence of death due to prostate cancer remained stable after about 10 years of follow-up. At 12 years, 12.5% of the surgery group and 17.9% of the watchful waiting group had died of prostate cancer (difference = 5.4%, 95% confidence interval [CI] = 0.2 to 11.1%), for a relative risk of 0.65 (95% CI = 0.45 to 0.94, P =. 03). The difference in cumulative incidence of distant metastases did not increase beyond 10 years of follow-up. At 12 years, 19.3% of men in the surgery group and 26% of men in the watchful waiting group had been diagnosed with distant metastases (difference = 6.7%, 95% CI = 0.2 to 13.2%), for a relative risk of 0.65 (95% CI = 0.47 to 0.88, P =. 006). Among men who underwent radical prostatectomy, those with extracapsular tumor growth had 14 times the risk of prostate cancer death as those without it (RR = 14.2, 95% CI = 3.3 to 61.8, P <. 001). Conclusion: Radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery. © The Author 2008. Published by Oxford University Press.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45611 (URN)10.1093/jnci/djn255 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Marklund-Bau, H., Spångberg, A. & Edéll-Gustafsson, U. (2008). Sleep and specific quality of life (QOL) in partners of men with lower urinary tract symptoms (LUTS) compared with partners to men from the population.
Open this publication in new window or tab >>Sleep and specific quality of life (QOL) in partners of men with lower urinary tract symptoms (LUTS) compared with partners to men from the population
2008 (English)Article in journal (Refereed) Submitted
Abstract [en]

Objective: To determine whether there are significant differences in sleep, partner specific and health related quality of life between partners of men with LUTS suggestive of benign prostatic obstruction (BPO) and partners of men from the population. Secondly, to identify factors related to the specific quality of life in partners of men with LUTS and the sleep efficiency.

Subjects and methods: The study designs were descriptive and comparative. The subjects were partners of men with LUTS suggestive of BPO (n=126) referred to departments of urology at one university and two general hospitals and partners (n=131) of randomly selected men from the general population. Self-administered questionnaires about demography, comorbidity, sleep, sexuality, partner specific and health related quality of life were used.

Results: Partners to men with LUTS suggestive of BPO were significantly more affected in all variables measuring partner specific quality of life compared to partners from the population. The most impaired aspects were compassion and worry about an operation or cancer.

In logistic regression, the only explanatory factors were having a partner belonging to the LUTS group for impaired partner specific quality of life and having a bed partner for high sleep efficiency.

There were no significant differences between the two groups regarding the quantity andquality of sleep or the health related quality of life.

Conclusions: The partner specific quality of life was impaired in partners of men with LUTS suggestive of BPO. Sleep and health related quality of life did not differ between partners of men with LUTS and partners in the population.

Keywords
Benign prostatic hyperplasia, Insomnia, Lower urinary tract symptoms, Partner, Quality of life, Sleep disorders
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-15945 (URN)
Available from: 2008-12-17 Created: 2008-12-17 Last updated: 2009-08-19Bibliographically approved
Marklund-Bau, H., Edéll-Gustafsson, U. & Spångberg, A. (2007). Bothersome urinary symptoms and disease-specific quality of life in patients with benign prostatic obstruction: High prevalence of urinary incontinence before and after intervention. Scandinavian Journal of Urology and Nephrology, 41(1), 32-41
Open this publication in new window or tab >>Bothersome urinary symptoms and disease-specific quality of life in patients with benign prostatic obstruction: High prevalence of urinary incontinence before and after intervention
2007 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 41, no 1, p. 32-41Article in journal (Refereed) Published
Abstract [en]

Objectives: Firstly, to describe self-reported urinary symptoms and bothersomeness, including disease-specific quality of life (QOL), in patients with symptomatic benign prostatic obstruction (BPO) before and 6 months after intervention. Secondly, to identify factors which predict disease-specific QOL. Thirdly, to develop and test the reliability of an instrument to evaluate incontinence, the Linköping Incontinence Questionnaire (LIQ). Finally, to translate and test the reliability of Swedish versions of the International Prostate Symptom Score, including the bother question, the American Urological Association Symptom Problem Index (SPI) and the Benign Prostatic Hyperplasia Impact Index.

Material and methods: Disease-specific QOL was studied in 572/720 consecutively treated patients using structured questionnaires. The reliability of the instruments was tested in 122 patients with lower urinary tract symptoms (LUTS) or BPO.

Results: The frequency and weak stream items of the SPI were among those that best explained the patients' disease-specific QOL both before and after intervention. Before and after intervention the prevalence of urinary incontinence, assessed using the LIQ instrument, was 46% and 16%, respectively. Symptoms and disease-specific QOL improved most in the surgery group, intermediately in the transurethral incision of the prostate/transurethral microwave thermotherapy group and least in the drug therapy group.

Conclusions: The frequency and weak stream items of the SPI were the factors that best explained disease-specific QOL. The prevalence of incontinence before and after intervention was higher than that previously

Place, publisher, year, edition, pages
Taylor & Francis, 2007
Keywords
Benign prostatic obstruction, benign prostatic hyperplasia, disease-specific quality of life, interventions, lower urinary tract symptoms, predicting factors, treatment, urinary incontinence, urinary symptoms
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-15942 (URN)10.1080/00365590601068926 (DOI)
Available from: 2008-12-17 Created: 2008-12-17 Last updated: 2017-12-14Bibliographically approved
Schelin, S., Geertsen, U., Walter, S., Spångberg, A., Duelund-Jacobsen, J., Kroyer, K., . . . Nordling, J. (2006). Feedback microwave thermotherapy versus TURP/prostate enucleation surgery in patients with benign prostatic hyperplasia and persistent urinary retention: A prospective, randomized, controlled, multicenter study. Urology, 68(4), 795-799
Open this publication in new window or tab >>Feedback microwave thermotherapy versus TURP/prostate enucleation surgery in patients with benign prostatic hyperplasia and persistent urinary retention: A prospective, randomized, controlled, multicenter study
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2006 (English)In: Urology, ISSN 0090-4295, E-ISSN 1527-9995, Vol. 68, no 4, p. 795-799Article in journal (Refereed) Published
Abstract [en]

Objectives: To assess the clinical efficacy of ProstaLund Feedback Treatment (PLFT) using the CoreTherm device versus transurethral resection of the prostate (TURP) and prostate enucleation surgery. Methods: We performed a prospective, randomized, controlled, multicenter study of 120 patients with symptomatic benign prostatic hyperplasia and persistent urinary retention requiring an indwelling catheter or clean intermittent catheterization. The primary efficacy variables were success in catheter removal and symptom improvement. Results: Of the 120 patients, 79% and 88% were catheter free after PLFT and surgery, respectively. The bother score (quality-of-life question) decreased from 4.6 in both groups before treatment to 1.4 in the PLFT group and 0.8 in the surgery group at 6 months of follow-up. The peak urinary flow rate was 13.4 mL/s after PLFT and 18.0 mL/s after surgery. The mean catheterization time was 34 days in the PLFT group and 5 days in the surgery group. Conclusions: PLFT is an effective alternative to surgical treatment in this group of catheterized patients. The risk of severe complications is reduced using PLFT, and an excellent treatment option can thereby be offered to this high-risk patient group who earlier could be treated only with lifelong catheterization. © 2006 Elsevier Inc. All rights reserved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-37610 (URN)10.1016/j.urology.2006.05.020 (DOI)36688 (Local ID)36688 (Archive number)36688 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
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