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Biomedical subjects

A Mattiasson

Publications and source records attributed to A Mattiasson.

At least 19 recordsLinked to original sources
PubMed2004

Clinical experiences with desmopressin for long-term treatment of nocturia.

PURPOSE: To our knowledge we report the first long-term use of desmopressin for nocturia. Patients previously responding to desmopressin in short-term studies were enrolled in this long-term open label study. MATERIALS AND METHODS: Patients received treatment for 10 or 12 months with the optimal desmopressin dose (0.1, 0.2 or 0.4 mg orally at bedtime). Patients were followed a further month without treatment. Of the patients completing the short-term study 132 males (92%) and 117 females (83%) were recruited, and 95 (72%) and 87 (75%), respectively, completed long-term treatment. RESULTS: The mean number of nocturnal voids was decreased in males and females throughout the study (1.3 to 1.6 and 1.2 to 1.3) compared with baseline (3.1 and 2.9, respectively). After followup the number of voids increased after treatment cessation. From baseline to 12 months the mean duration of the first sleep period gradually increased in males (157 to 288 minutes) and females (142 to 310 minutes). After followup the mean duration of the first sleep period decreased, confirming that it was a treatment related benefit. Desmopressin was well tolerated with few males (14%) or females (10%) withdrawing due to adverse events. Most adverse events were mild (44%) or moderate (44%) in severity. Four males experienced serious drug related adverse events, namely dizziness in 1, cardiac failure, headache and vomiting in 2, and chest pain and hypertension in 1. A female experienced 4 serious drug related adverse events, that is hyponatremia, headache, nausea and vertigo. Two patients had clinically significant hyponatremia. CONCLUSIONS: This long-term study shows that desmopressin is a generally well tolerated and effective treatment for nocturia.

Adult↗
PubMed2004

The cost of feedback microwave thermotherapy compared with transurethral resection of the prostate for treating benign prostatic hyperplasia.

OBJECTIVE: To compare the efficacy of a new microwave thermotherapy for treating benign prostatic hyperplasia (BPH), the ProstaLund Feedback Treatment (PLFT, ProstaLund Operations AB, Lund, Sweden) and transurethral resection of the prostate (TURP) in a clinical trial to their effectiveness in clinical practice over 1 year, to estimate their cost over 1 year, and to evaluate the cost of re-interventions over a longer period (2-3 years). PATIENTS AND METHODS: In a large randomized international 1-year clinical trial PLFT was as effective as TURP in improving symptoms of BPH and urinary flow. Because PLFT is an outpatient procedure it was less costly than TURP. However, the cost-effectiveness of the new procedure depends on its long-term effectiveness in clinical practice. All 146 patients in the randomized clinical trial were included in the present analysis. The outcome was based on the International Prostate Symptom Score (IPSS) and the bother score, and costs were estimated from treatment-related adverse events and hospitalization. To validate the estimates based on the clinical trial 1-year data on effectiveness and complete resource use in clinical practice were collected in a retrospective observational study from hospital charts and patient questionnaires of 88 patients who had undergone either TURP or PLFT. To assess the number of re-interventions after TURP after the first year information was obtained from hospital and surgical procedure data in the Swedish inpatient registry. The 3-year data for a total of 52,010 patients who had an index hospitalization for TURP between 1990 and 1995 were available for the analysis. The estimate of long-term consequences of PLFT was based on complication and re-intervention data for 87 patients who had undergone PLFT between 1997 and 1999. RESULTS: The mean 1-year costs in the clinical trial were estimated at [symbol: see text] 1763 for PLFT and [symbol: see text] 3209 for TURP. When all treatment-related resource use in clinical practice for 88 patients was included the costs were estimated at [symbol: see text] 1924 and [symbol: see text] 3264 for PLFT and TURP, respectively. The IPSS and bother scores were not significantly different between the groups in both datasets. Using the registry data the cost of TURP including re-interventions (TURP and bladder neck incisions) was estimated at [symbol: see text] 3159 over 2 years and [symbol: see text] 3185 over 3 years; the respective costs for PLFT were [symbol: see text] 2121 and at [symbol: see text] 2151. CONCLUSIONS: In the 1-year clinical trial PLFT was as effective but less costly than TURP, but long-term data are still lacking. However, the preliminary analysis over 3 years indicates that the average cost of the procedure remains lower than the total cost of TURP for the same period.

Aged↗
PubMed2003

Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder.

OBJECTIVES: To compare the efficacy of tolterodine plus simplified bladder training (BT) with tolterodine alone in patients with an overactive bladder. PATIENTS AND METHODS: In a multicentre, single-blind study at 51 Scandinavian centres, 505 patients aged >or= 18 years with symptoms of urinary frequency (>or= 8 micturitions/24 h) and urgency, with or without urge incontinence, were randomized to oral treatment with either tolterodine 2 mg twice daily plus simplified BT or tolterodine alone. Changes in voiding diary variables were evaluated after 2, 12 and 24 weeks of treatment. The patients' perceptions of their bladder symptoms and tolerability (adverse events) were also determined. RESULTS: In all, 501 patients (75% women) were evaluable on an intention-to-treat basis (244 on tolterodine + BT and 257 on tolterodine alone). Tolterodine significantly reduced the voiding frequency and increased the volume voided per void at all sample times; these effects were significantly increased by adding BT. At the end of the study the median percentage reduction in voiding frequency was greater with tolterodine + BT than with tolterodine alone (33% vs 25%, P < 0.001), while the median percentage increase in volume voided per void was 31% with tolterodine + BT and 20% with tolterodine alone (P < 0.001). There was a median of 81% fewer incontinence episodes than at baseline with tolterodine alone, which was not significantly different from that with tolterodine + BT (- 87%). The two groups had comparable median percentage reductions in urgency episodes. Some 76% of patients on tolterodine + BT reported an improvement in their bladder symptoms relative to baseline, compared with 71% on tolterodine alone. Tolterodine was well tolerated; the most common adverse event was mild dry mouth. CONCLUSION: Tolterodine 2 mg twice daily is an effective and well tolerated treatment for an overactive bladder, the effectiveness of which can be augmented by a simplified BT regimen.

Administration, Oral↗
PubMed2003

Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia.

OBJECTIVES: To assess the effect of nocturia on productivity, vitality and utility in a selected group of professionally active individuals with nocturia, compared with matched controls, and investigate the effect of symptom severity, to test the hypothesis that lack of sleep caused by frequent sleep interruptions could reduce an individuals' daytime energy and activity levels. SUBJECTS AND METHODS: Subjects (203) were recruited in Sweden through advertisements, and their suitability for the study assessed in a structured interview. Controls (80) matched for age and gender were randomly selected from a market research panel and given the same interview. Both groups completed a productivity questionnaire, a generic quality-of-life questionnaire with a specific domain for vitality and a utility instrument. RESULTS: The study group with nocturia had a significantly lower level of vitality and utility, and greater impairment of work and activity, than the control group. Women were more affected than men. Symptom severity correlated with all three measures. CONCLUSIONS: In an otherwise healthy and professionally active group of individuals, waking at night to void significantly diminishes their overall well-being, vitality and productivity, leading to a significant level of indirect and intangible costs.

Absenteeism↗
PubMed2002

Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men.

OBJECTIVE: To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men. PATIENTS AND METHODS: Men aged >/=18 years with verified nocturia (>or=two voids/night) and nocturnal urine production greater than their maximum functional bladder capacity were recruited. A 3-week dose-titration phase established the optimum desmopressin dose (0.1, 0.2 or 0.4 mg). After a 1-week 'washout' period, patients who responded in the dose-titration period were randomized to receive the optimal dose of desmopressin or placebo in a double-blind design for 3 weeks. RESULTS: In all, 151 patients entered the double-blind period (86 treated with desmopressin, 65 with placebo). In the desmopressin group 28 (34%) patients and in the placebo group two (3%) patients (P<0.001) had fewer than half the number of nocturnal voids relative to baseline; the mean number of nocturnal voids decreased from 3.0 to 1.7 and from 3.2 to 2.7, respectively, reflecting a mean decrease of 43% and 12% (P<0.001). The mean duration of the first sleep period increased by 59% (from 2.7 to 4.5 h) in the desmopressin group, compared with an increase of 21% (from 2.5 to 2.9 h) in the placebo group (P<0.001). The mean nocturnal diuresis decreased by 36% (from 1.5 to 0.9 mL/min) in the desmopressin group and by 6% (from 1.7 to 1.5 mL/min) in the placebo group (P<0.001). The mean ratio of night/24-h urine volume decreased by 23% and 1% (P<0.001), and the mean ratio of night/day urine volume decreased by 27% and increased by 3% (P<0.001) for the desmopressin and placebo groups, respectively. In the double-blind treatment period, similar numbers of patients had adverse events; 15 (17%) patients in the desmopressin and 16 (25%) patients in the placebo group. Most adverse events were mild. Serum sodium levels were <130 mmol/L in 10 (4%) patients and this occurred during dose-titration. CONCLUSIONS: Orally administered desmopressin is an effective and well-tolerated treatment for nocturia in men.

Administration, Oral↗
PubMed2000

Cell-kill modeling of microwave thermotherapy for treatment of benign prostatic hyperplasia.

PURPOSE: We investigated whether cell-kill modelling could be used as a mean for predicting the outcome of microwave thermotherapy for benign prostate hyperplasia (BPH). METHODS: The two models--Henriques' damage integral and Jung's compartment model--were implemented in a computer program. Real treatment data for 22 patients with BPH who were in chronic retention were used as input, including measured intraprostatic temperatures and microwave power. To test if modelling gives results that are consistent with actual observations, comparison with transrectal ultrasound (TRUS) measurements of the prostate volume before and after treatment was made. The sensitivity of the computer model for variations in the heat cytotoxicity and the temperature probe location in the adenoma was also tested. RESULTS: The average TRUS volume reduction 3 months after treatment was 26 cc, whereas the corresponding cell kill calculation was 27 cc. The computer model appears to be rather insensitive to minor uncertainties in heat sensitivity and location of the intraprostatic reference temperature sensors. CONCLUSION: Cell-kill modelling appears to give results that are consistent with actual observations. The coagulated tissue volume is calculated in real time during the treatment, thereby providing an immediate prediction of the treatment outcome. By using cell-kill modelling, the endpoint of a treatment can be set individually; e.g., when a certain volume reduction has been achieved.

Cell Death↗
PubMed2000

Aspects on transurethral microwave thermotherapy of benign prostatic hyperplasia.

The underlying principle behind new minimal invasive procedures, such as microwave thermotherapy, is to coagulate the prostatic adenomatous tissue by means of heat. This article describes the action of heat on tissue and identifies areas of concern during treatment. The extent of the necrosis during treatment is governed by two physical variables: the intraprostatic temperature and the duration of the heat exposure. The prostatic blood flow is a key factor for the outcome of microwave treatment because it acts as a coolant and may effectively sink the temperature in the treatment area. Blood flow can vary substantially between patients and may change significantly during treatment. By measuring the intraprostatic temperature and varying the microwave power accordingly, it is possible to compensate for the large variations in prostatic blood flow and obtain consistent treatment.

Humans↗
PubMed1999

Cortical magnetic stimulation in patients with genuine stress incontinence: correlation with results of pelvic floor exercises.

Pelvic floor training is an established conservative method of treatment in patients with genuine stress incontinence. It is not known why only a proportion of patients benefit from this form of treatment, while others with a comparable degree of incontinence do not. Since muscle awareness is of vital importance in pelvic floor training, we decided to investigate whether differences in outcome might be explained by differences in cortical control of the pelvic floor muscles. The function in the total motor pathway to the pelvic floor muscles was examined with cortical magnetic stimulation and circumvaginal EMG recording. Since lesions of the peripheral motor pathway have been demonstrated in patients with genuine stress incontinence, possible differences at this level were investigated by means of terminal pudendal motor latencies, using electrical nerve stimulation and anal recording EMG. We found that patients who succeeded with pelvic floor exercises for genuine stress incontinence had a significantly higher probability of response to cortical magnetic stimulation and significantly larger response amplitudes than the patients who did not benefit from training. The findings in the latter group did not differ from those of a healthy control group. No differences between the groups were found in the terminal pudendal motor latencies. We conclude that women with genuine stress urinary incontinence, successfully alleviated by a physiotherapeutic training program, have a higher degree of corticofugal control of their perineal muscles than women who do not succeed with the same treatment program and healthy controls. Neurourol. Urodynam. 18:437-445, 1999.

Adult↗
PubMed1999

Female stress, urge, and mixed urinary incontinence are associated with a chronic and progressive pelvic floor/vaginal neuromuscular disorder: An investigation of 317 healthy and incontinent women using vaginal surface electromyography.

Reduction of the maximum vaginal surface electromyography (EMG) activity has previously been demonstrated in women with stress, urge, and mixed incontinence in comparison with healthy volunteers [Gunnarsson and Mattiasson, Scand J Urol Nephol 157:89-95, 1994]. The present study was performed to investigate if these EMG changes are age dependent and whether healthy parous women in general might show an age-related decrease of vaginal and pelvic neuromuscular activity. A total of 317 women, 144 with urinary incontinence and 173 healthy volunteers, 20 to 76 years of age, were investigated. The maximum EMG activity during repeated short contractions (2 s) was measured. We found that parous women who have maintained continence through the years had a normal pelvic floor function as estimated with vaginal surface EMG. In contrast, all three groups of incontinent women showed a successive decrease of the EMG activity with increasing age. This difference was highly significant (P < 0.001) in women above the age of 50. No significant differences could be seen between groups when stress, urge, and mixed incontinent women were compared. Even though any convincing correlation between the amount of urinary leakage and the reduction of EMG activity was not found, we conclude that a chronic and progressive deterioration of the pelvic-vaginal neuromuscular function occurs in women who develop urinary incontinence. The results support the view that a common pathophysiological mechanism in patients with stress, urge, and mixed incontinence might exist. The findings might help to establish a new perspective for the understanding of the pathophysiology, diagnosis, treatment, and prevention of female incontinence. Neurourol. Urodynam. 18:613-621, 1999.

Adult↗