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After about 13 years of follow-up, men <65 years of age with prostate cancer diagnosed on the basis of obstructive urinary symptoms (rather than elevated prostate-specific antigen levels) and assigned to radical prostatectomy, as compared with watchful waiting, have improved survival. The randomized Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) showed that radical prostatectomy decreased the risk of metastases, the rate of death from prostate cancer, and the rate of death from any cause. 1 – 3 Although the participants in SPCG-4 were predominantly men whose cancers were detected on the basis of symptoms, rather than by elevated prostate-specific antigen (PSA) levels, prostate-cancer events have also accumulated during an extended follow-up period in a subgroup of men with low-risk disease. Determining whether there is a survival benefit for men with low-risk disease is relevant in light of the risk of overdiagnosis resulting . . .

To evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality. Individual participant data meta-analysis. Cohorts from 40 countries with data collected between 1970 and 2017. Adults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607). GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m ) and all cause mortality. Over a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index. Elevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

After 4 years of the GÖTEBORG-2 trial, MRI-targeted biopsy led to less detection of clinically insignificant prostate cancer than systematic biopsy without compromising the detection of cancer that may affect survival.

Regional, population-based organised prostate cancer testing (OPT) began in Sweden in 2020. We investigated associations between participation and neighbourhood characteristics. Region Västra Götaland's OPT programme. Data were retrieved from the regional OPT database, for all 50-year-old men invited in 2020-2021. Addresses were linked to demographic statistical areas defined and socioeconomically described by Statistics Sweden. Logistic regression models were used to analyse participation based on neighbourhood deprivation, income, education, proportion of non-western immigrants, and degree of urbanisation, categorised in quintiles. Results are reported as unadjusted and adjusted odds ratios (ORs) with confidence intervals (CIs). Unadjusted participation was significantly lower in the quintiles of neighbourhoods with the highest deprivation index (OR 0.61, 95% CI 0.56-0.67), lowest income (OR 0.64, 95% CI 0.59-0.71), lowest education (OR 0.81, 95% CI 0.74-0.89), and highest proportion of non-Western immigrants (OR 0.70, 95% CI 0.64-0.77), compared with the opposite quintile. After adjustment for the other variables, significant gradients remained for deprivation (OR 0.65, 95% CI 0.57-0.74), proportion of non-Western immigrants (OR 0.78, 95% CI 0.69-0.88), and degree of urbanization (OR 0.78, 95% CI 0.71-0.87 for rural versus urban areas). No adjusted analysis was done for income owing to its strong correlation with deprivation. Socioeconomic factors and degree of urbanisation influence participation in organised screening for prostate cancer. Actively inviting men for screening, does not in itself avoid socioeconomic disparity in early detection of prostate cancer.

This study aimed to evaluate the clinical impact of implementing routine emergency computed tomography (eCT) for all patients presenting with suspected acute renal colic at the emergency department (ED). We did a retrospective observational study of all patients who underwent eCT for suspected acute renal colic at the ED in Helsingborg between May 9, 2023 and May 8, 2024 and compared with a 2019/2020 cohort not using routine eCT. Of 66,540 ED visits during the study period, 1,566 patients underwent eCT for suspected acute renal colic; 1,261 were included in the analysis after exclusions. In 57% of patients, no symptomatic stone was identified; nevertheless, one fifth required hospital admission for alternative diagnoses. A radiologically proven stone explaining their symptoms was found in 43% of patients. Compared with the 2019/2020 cohort, the 2023/2024 cohort had more treatments (33% vs 21%), and significantly shorter time to both treatment (p = 0.01) and clinical closure (p <0.001). Stone size, location, type of treatment and number of visits to the ED were comparable between the two cohorts. Acute renal colic in its clinical presentation appeared to be less diagnostically reliable than previously assumed. The use of eCT ensured accurate diagnosis of urolithiasis, significantly shortened time to treatment, and to a stone-free patient as well as reduced the use of stents. We propose that eCT should be implemented as a routine procedure in the management of acute renal colic.

General practitioners (GPs) do not see men with localised urinary tract infection (UTI) very often which limits their possibility of developing expertise in the area. To gain knowledge of male patients' experiences and perspectives on localised UTIs, qualitative research is needed. To explore expectations, experiences and symptoms in men with localised urinary tract infection in primary health care (PHC). A qualitative study based on semi-structured interviews with men with a history of localised UTI treated in PHC was performed. Data were collected from patients with recent experience of localised UTI, using semi-structured interviews. An interview guide with open-ended questions was used. All interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. The median age of the 18 patients was 77.5 years. The interviews lasted an average of 16 min. Four themes emerged: (1) stigma and self-blame in managing illness. (2) Adaptation, careful planning and normalization. (3) Gender and help seeking behaviour. (4) Healthcare experience-uncertainty and trust. Many patients reflected on the causes behind their infection and expressed aspects of self-infliction. They explained that symptoms from the localised UTI affected their daily lives and adjusted their way of living according to them. Localised UTI symptoms in men affect their daily lives. GPs should be perceptive regarding any beliefs among patients with localised UTI, as well as any self-imposed guilt that could lead to unnecessary lifestyle changes. Although the patients in this study expressed good confidence in health care, they also found the care not individualized enough.

The main aim of the study was to determine the impact of diagnostic activity and life expectancy on the lifetime risk of a prostate cancer diagnosis. We used a state transition simulation model based on Swedish population-based data to simulate life trajectories for 2,000,000 men from age 40 to 100 in order to estimate the lifetime risk of a prostate cancer diagnosis. Risk estimates were determined by the level of diagnostic activity and estimated life expectancy. Higher exposure to diagnostic activity resulted in more prostate cancer diagnoses. This was especially true for men diagnosed with low or intermediate grade disease. Men exposed to high diagnostic compared to low diagnostic activity had a five-fold increased lifetime risk (22% vs. 5%) of being diagnosed with a low or intermediate-risk prostate cancer and half the risk of being diagnosed with a high-risk prostate cancer (6% vs. 13%). Men with a long life expectancy had a higher lifetime risk of a prostate cancer diagnosis both overall (21% vs. 15%) and in all risk categories when compared to men with a short life expectancy. The lifetime risk of a prostate cancer diagnosis is strongly influenced by diagnostic activity and to a lesser degree by life expectancy.

The aim of the study was to assess the preoperative and intraoperative potential risk factors for infectious complications after percutaneous nephrolithotomy (PCNL). A total of 303 patients who underwent PCNL for renal stones were included in the recent study. A detailed history including past renal surgery, nephrostomy insertion and recurrent urinary infection were obtained from all patients. Preoperative urine culture, renal pelvic urine culture and stone culture were obtained from all patients. The intraoperative data were prospectively noted. All patients were followed up postoperatively for signs of systemic inflammatory response syndrome (SIRS) and sepsis. In 83 (27.4 %) of the patients, SIRS was observed and of these patients 23 (7.6 %) were diagnosed as sepsis. Escherichia coli was the most common organism detected in cultures, followed by Pseudomonas aeruginosa, Enterococcus and Klebsiella spp. in all patients. By multivariate logistic regression analysis, presence of infection stone, stone burden and recurrent urinary tract infection were associated with both SIRS and sepsis development. Presence of infection stone, stone burden >=800 mm^sup 2^ and recurrent urinary tract infection can be identified as independent predictors for the development of SIRS and sepsis.

Background Severe COVID-19 frequently involves multi-organ dysfunction, including acute kidney injury (AKI), which affects up to 85% of critically ill patients. While both direct viral infection and systemic effects are implicated, the role of renal microthrombosis remains poorly defined in COVID-19 and AKI. Angiopoietin-2, a pro-inflammatory cytokine, and cleaved thrombomodulin is elevated in plasma in severe COVID-19 and has been linked to endothelial dysfunction and hypercoagulability. We hypothesize that renal microthrombi can contribute to decreased kidney function in critically ill COVID-19 patients. Methods We performed histopathological and molecular analyses of postmortem kidney tissue from seven critically ill COVID-19 patients. Control tissue was obtained from nephrectomy specimens ( n  = 6) and postmortem tissue ( n  = 7). We assessed microthrombi, tubular necrosis, glomerulosclerosis, fibrosis, and expression of angiopoietin-2 and thrombomodulin. Immunofluorescence and SARS-CoV-2 nucleoprotein staining were used alongside clinical data. Results AKI was observed in six of seven COVID-19 patients. Compared to controls, COVID-19 kidneys showed a significant reduction in tubular nuclear area ( P  < 0.0003), presence of viral antigen in tubular epithelium, and marked glomerular and peritubular microthrombi (15.2 vs. 1.3 thrombi/mm²; P  < 0.0001). THBD expression was significantly reduced bith peritubular capillaries and glomeruli in COVID-19 kidneys. Glomerulosclerosis, glomerular area, and tubulointerstitial fibrosis were variable in both control and COVID-19 patients with no significant differences. Conclusions This study identifies widespread renal microthrombi, tubular necrosis, and reduced THBD expression in COVID-19 patients with AKI, supporting a role for endothelial dysfunction and microvascular thrombosis in COVID-19-associated renal injury. The data implicates the disruption of endothelial anticoagulant signaling through thrombomodulin as a contributing mechanism.

There are diverse results in terms of the association between body mass index (BMI) and mortality risk in patients with end-stage renal disease (ESRD). The aim was to examine if there is an association between BMI and the risk of all-cause mortality in patients with diabetes mellitus (DM) and ESRD on hemodialysis (HD) or peritoneal dialysis (PD). Included were 3,235 patients (mean age 66 ± 14 years, 66% men) with DM on dialysis treatment (2,452 HD, 783 PD) that were followed for 3.9 ± 3.5 years. BMI was calculated as weight (kg)/[height (m)] and defined as the mean BMI value during the study period. Relationships between BMI and all-cause mortality were examined by Cox-models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses adjusted for demographics, laboratory findings and comorbidity. BMI between 18.5 and 25 kg/m was used as the reference group. During the study, 1,688 (53%) patients died (1,275 on HD, 413 on PD). In multivariate analyses, patients on HD with BMI ≤ 18.5 kg/m had an increased risk of all-cause mortality (HR1.94, CI 1.47-2.54). In contrast, mortality risk was decreased in the BMI groups of 25.1-30 kg/m (HR0.84, CI0.73-0.96), 30.1-35 kg/m (HR0.66, CI0.55-0.78), and 35.1-40 kg/m (HR0.65, CI0.49-0.85). In multivariate analyses, no associations between BMI and mortality risk were found in patients on PD. An increased risk of mortality in underweight DM patients on HD was found. Overweight, class 1 and class 2 obesity were associated with better survival in HD. The association between BMI and risk of mortality is different in patients with DM on maintenance HD or PD. The association between BMI and risk of mortality in ESRD population on dialysis treatment is very divers and different study have shown different results. High BMI associated with better survival in patients with diabetes and HD but this finding did not observed with PD. The importance to examine time-varying BMI frequently as independent covariance in patients with dialysis treatment.