Papers by Thomas Davidsson
Scandinavian Journal of Urology and Nephrology, 1999
We report a case of symptomatic intermittent upper tract obstruction in a continent urinary reser... more 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..
European Urology, 2013
Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the... more Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after
Transurethral Resection of Non-Muscle-Invasive Bladder Transitional Cell Cancers With or Without 5-Aminolevulinic Acid Under Visible and Fluorescent Light: Results of a Prospective, Randomised, Multicentre Study
Keywords: Bladder cancer Transitional cell carcinoma Non-muscle-invasive 5-ALA Multicentre phase ... more Keywords: Bladder cancer Transitional cell carcinoma Non-muscle-invasive 5-ALA Multicentre phase 3 clinical trial Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. Abstract Background: Fluorescent light (FL)-guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has been reported to detect more tumours compared with standard white-light (WL) cystoscopy. Most reports are from single centres with relatively few patients. Objective: To evaluate whether 5-ALA-induced FL and WL cystoscopy at transurethral resection (TUR) is superior compared with standard procedures under WL only with respect to tumour recurrence and progression in patients with non-muscle-invasive bladder cancer. Design, setting, and participants: This randomised, multicentre, observer-and pathologist-blinded, prospective phase 3 clinical trial enrolled 300 patients, and of those patients, 153 were randomised to FL cystoscop...
BJU international, Jan 29, 2017
To investigate the long-term functional outcomes and complications after continent cutaneous dive... more To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch. Complications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files. A complication of Clavien-Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one re-operation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during the first half of the study period than during the second half (2000-2007; 62% vs 47%; P = 0.03), and they were also more frequent in patients who underwent surgery for benign causes than in patients who underwent surgery for malignancy (60% vs 51%; P = 0.04). Continence was achieved in 172/18...
Filtering Element for Use in a Filtering Device
Lower urinary tract reconstruction in patients with bladder cancer
Invasive Bladder Cancer, 2007
Bone mineralization after urinary diversion
Second Edition, 1988
PLOS ONE
Patients with bladder cancer need frequent controls over long follow-up time due to high recurren... more Patients with bladder cancer need frequent controls over long follow-up time due to high recurrence rate and risk of conversion to muscle invasive cancer with poor prognosis. We identified cancer-related molecular signatures in apparently healthy bladder in patients with subsequent muscular invasiveness during follow-up. Global proteomics of the normal tissue biopsies revealed specific proteome fingerprints in these patients prior to subsequent muscular invasiveness. In these presumed normal samples, we detected modulations of proteins previously associated with different cancer types. This study indicates that analyzing apparently healthy tissue of a cancer-invaded organ may suggest disease progression.
Continent Cutaneous Diversion Am Lundiana - Complications from Reservoir and Outlet
European Urology Supplements, 2011
Urological Research, 1999
Incorporation of bowel into the bladder (enterocystoplasty) has been widely used to increase blad... more 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 a-agonists and ATP) to that of the bladder (contraction to a-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 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 sacri®ced and the bladders mounted as wholemounts and stained for acetylcholinesterase-containing nerves, or embedded in paran 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 seg-ment. 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.
European Urology, 2010
BackgroundFluorescent light (FL)–guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has b... more BackgroundFluorescent light (FL)–guided cystoscopy induced by 5-aminolevulinic acid (5-ALA) has been reported to detect more tumours compared with standard white-light (WL) cystoscopy. Most reports are from single centres with relatively few patients.
Tapering of intussuscepted ileal nipple valve or ileocecal valve to correct secondary incontinence in patients with urinary reservoir
The Journal of urology, 1992
Malfunction of the outlet mechanism, that is leakage of urine or difficulty in catheterization, h... more 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.
Absorption of sodium and chloride in continent reservoirs for urine: comparison of ileal and colonic reservoirs
The Journal of urology, 1994
The absorptive capacity of urinary reservoir mucosa was studied by measuring the fractions of 22s... more 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.
Effect of platelet aggregation inhibitors on the rate of thrombectomy following arterial reconstructions with Gore-Tex prostheses: a retrospective study
VASA. Zeitschrift für Gefässkrankheiten, 1982
The detubularized right colonic segment as urinary reservoir: evolution of technique for continent diversion
The Journal of Urology
Continent diversion of urine via a cecal-right colonic reservoir has been performed at our univer... more Continent diversion of urine via a cecal-right colonic reservoir has been performed at our university hospital since 1977. Several modifications of surgical technique have been devised to prevent problems of urinary leakage and difficulties in catheterization. The current technique, used during the last 3 years on 14 patients, involves use of a detubularized right colonic segment as a reservoir, ileal mesenteric exclusion, fashioning the intussuscepted ileal nipple valve with staples and anchoring of a fascia strip sling around the nipple base to the anterior rectus sheath. Complication from the reservoir outlet occurred in only 1 patient.
Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement
The Journal of Urology
Urodynamic evaluation was performed in 13 men 4 to 18 months after cystoprostatectomy and bladder... more 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...
471 Long-term outcome after continent cutaneous diversion a.m. Lundiana in 198 patients
European Urology Supplements, 2015
Preoperative staging of locally advanced bladder cancer before radical cystectomy using 3 tesla magnetic resonance imaging with a standardized protocol
Scandinavian Journal of Urology, 2013
The correlation between clinical tumour stage and pathological tumour stage in radical cystectomy... more The correlation between clinical tumour stage and pathological tumour stage in radical cystectomy specimens in locally advanced bladder cancer is suboptimal. Radiological methods have so far been of limited value in preoperative staging; however, the resolution with magnetic resonance imaging (MRI) has improved with further technical developments of the method. The aim of this study was to compare tumour stage at MRI with pathological tumour stage in the cystectomy specimen. Prospectively, 53 patients with invasive bladder cancer were preoperatively investigated with 3 tesla (3T) MRI using a standardized protocol. 3T MRI was performed at a standardized bladder volume. Clinical tumour stage, tumour stage at MRI and pathological tumour stage groups (Ta, Cis, T1/T2a, T2b/T3a, T3b/T4a), were compared, and sensitivity and specificity for organ-confined and non-organ-confined disease (stage T3a or above or lymph-node metastases) were analysed. MRI overestimated tumour stage in 23 out of 47 patients (49%), whereas six patients (13%) were understaged. In the three groups of patients (those with the same stage group at MRI as in the cystectomy specimen, overestimated tumour stage and understaged patients), the time interval between transurethral resection of the bladder (TURB) and MRI did not differ significantly. Preoperative MRI overestimated tumour stage in almost half of the patients investigated in this study. Postoperative changes could have contributed to such overstaging with MRI.
The right colonic segment as reservoir for urine
Scandinavian journal of urology and nephrology. Supplementum, 1992
Rediversion after urinary diversion: a single-centre experience
Scandinavian journal of urology, 2014
This study aimed to reveal the late results of rediversion after urinary diversion. From 1985 to ... more This study aimed to reveal the late results of rediversion after urinary diversion. From 1985 to 2009, 28 patients underwent rediversion at the Department of Urology, Lund University Hospital, Sweden. Median follow-up after rediversion was 147 months (range 7-300 months, interquartile range 63-214). The following rediversions were performed: ileal conduit, cutaneous ureterostomy, ureterosigmoidostomy and rectal bladder to continent cutaneous diversion (group I, n = 17); cutaneous ureterostomy to neobladder (group II, n = 1); ileal conduit and cutaneous ureterostomy to gastric conduit (group III, n = 2); and continent cutaneous diversion and neobladder to ileal conduit (group IV, n = 8). In group I, reoperations were necessary after rediversion in nine of the 17 patients. Excellent functional results were obtained in 14 patients. Two patients, both with Kock pouches, underwent multiple operations and finally required rediversion to an ileal conduit. The sole patient in group II had a...
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Papers by Thomas Davidsson