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Kruyt LM, van der Ploeg JM, Lammers K, van Etten-Debruijn BA, Niemeijer AS, Hakvoort RA. Pessaries for pelvic organ prolapse: evaluation of vaginal discharge and pain during pessary cleaning in an outpatient setting. Int Urogynecol J 2024; 35:333-339. [PMID: 37796331 DOI: 10.1007/s00192-023-05648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pessary treatment for pelvic organ prolapse (POP) is effective and safe, but long-term continuation is low. Pain and vaginal discharge may play a role. This study was aimed at evaluating vaginal discharge and pain during pessary cleaning in an outpatient setting and in continuous pessary use. METHODS Women with POP who attended the outpatient clinic for pessary cleaning between January and October 2021 were included. Primary outcome was pain during removal and reinsertion of the pessary, measured by an 11-point numeric rating scale (NRS). Secondary outcome was vaginal discharge, measured by the NRS and Patient Global Impression of Change scale (PGI-C). Multiple linear regression analysis was used to identify associated variables for pain and discharge. RESULTS A total of 150 women were included. Mean NRS during pessary removal was 4.3 (± 2.7), with 25% of women scoring a 7 or higher. Mean NRS during reinsertion was 1.8 (± 2.0). A smaller genital hiatus and presence of vaginal atrophy or vulvar skin disease were associated with pain during pessary removal. Mean NRS for vaginal discharge was 2.5 (± 2.3). Twenty-five percent of women reported that their vaginal discharge was "(very) much worse" than before they used a pessary. Presence of vaginal erosions was associated with vaginal discharge in this study population. CONCLUSIONS Removing a pessary in an outpatient setting is a painful procedure for many women who use a pessary continuously. Moreover, 25% of these women experience an increase in vaginal discharge while using a pessary. Future research should focus on reducing these disadvantages.
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Affiliation(s)
- Lara M Kruyt
- Department Obstetrics & Gynecology, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands.
| | - J Marinus van der Ploeg
- Department Obstetrics & Gynecology, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands
| | - Karin Lammers
- Department Obstetrics & Gynecology, Ommelander Hospital, Scheemda, The Netherlands
| | | | | | - Robert A Hakvoort
- Department Obstetrics & Gynecology, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands
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Stelwagen J, Meuleman AT, Lubberts S, Steursma G, Kruyt LM, Donkerbroek JW, Meijer C, Walenkamp AME, Lefrandt JD, Rakers SE, Huitema RB, de Jong MAA, Wiegman EM, van den Bergh ACM, de Jong IJ, van Rentergem JAA, Schagen SB, Nuver J, Gietema JA. Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment. Cancers (Basel) 2021; 13:5675. [PMID: 34830829 PMCID: PMC8616311 DOI: 10.3390/cancers13225675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. METHODS In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)-with a follow-up duration ≥ 20 years-and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). RESULTS We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20-42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score -0.85; 95% CI -1.39 to -0.33) compared to controls (mean 0.67; 95% CI -0.21 to 1.57, p < 0.01). In univariate analysis, the presence of hypogonadism (β -1.50, p < 0.01), high c-PWV (β -0.35, p = 0.09), and high AGEs (β -1.27, p = 0.02) were associated with lower cognitive scores, while only AGEs (β -1.17, p = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, p < 0.01). CONCLUSIONS Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. TRIAL REGISTRATION NCT02572934.
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Affiliation(s)
- Johannes Stelwagen
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Andrea T. Meuleman
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Gerrie Steursma
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Lara M. Kruyt
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Jan W. Donkerbroek
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Coby Meijer
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Annemiek M. E. Walenkamp
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Joop D. Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Sandra E. Rakers
- Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (S.E.R.); (R.B.H.)
| | - Rients B. Huitema
- Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (S.E.R.); (R.B.H.)
| | - Marianne A. A. de Jong
- Department of Radiotherapy, Radiotherapeutic Institute Friesland, 8900 CC Leeuwarden, The Netherlands;
| | - Erwin M. Wiegman
- Department of Radiotherapy, Isala Hospital, 8025 AB Zwolle, The Netherlands;
| | - Alfons C. M. van den Bergh
- Department of Radiotherapy, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Igle J. de Jong
- Department of Urology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Joost A. Agelink van Rentergem
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands; (J.A.A.v.R.); (S.B.S.)
| | - Sanne B. Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands; (J.A.A.v.R.); (S.B.S.)
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
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Stelwagen J, Lubberts S, Steggink LC, Steursma G, Kruyt LM, Donkerbroek JW, van Roon AM, van Gessel AI, van de Zande SC, Meijer C, Gräfin Zu Eulenburg CH, Oosting SF, Nuver J, Walenkamp AME, Jan de Jong I, Lefrandt JD, Gietema JA. Vascular aging in long-term survivors of testicular cancer more than 20 years after treatment with cisplatin-based chemotherapy. Br J Cancer 2020; 123:1599-1607. [PMID: 32921790 PMCID: PMC7686327 DOI: 10.1038/s41416-020-01049-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/23/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Late effects of cisplatin-based chemotherapy in testicular cancer survivors (TCS) include cardiovascular morbidity, but little data is available beyond 20 years. The objective was to assess vascular damage in very long-term TCS. METHODS TCS (treated with chemotherapy or orchiectomy only) and age-matched healthy controls were invited. Study assessment included vascular stiffness with ultrasound measurement of carotid-femoral pulse wave velocity (cf-PWV). RESULTS We included 127 TCS consisting of a chemotherapy group (70 patients) and an orchiectomy group (57 patients) along with 70 controls. Median follow-up was 28 years (range: 20-42). The cf-PWV (m/s) was higher in TCS than in controls (geometrical mean 8.05 (SD 1.23) vs. 7.60 (SD 1.21), p = 0.04). The cf-PWV was higher in the chemotherapy group than in the orchiectomy group (geometrical mean 8.39 (SD 1.22) vs. 7.61 (SD 1.21), p < 0.01). In the chemotherapy group cf-PWV increased more rapidly as a function of age compared to controls (regression coefficient b 7.59 × 10-3 vs. 4.04 × 10-3; p = 0.03). CONCLUSION Very long-term TCS treated with cisplatin-based chemotherapy show increased vascular damage compatible with "accelerated vascular aging" and continue to be at risk for cardiovascular morbidity, thus supporting the need for intensive cardiovascular risk management. CLINICAL TRIAL REGISTRATION The clinical trial registration number is NCT02572934.
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Affiliation(s)
- Johannes Stelwagen
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Lars C Steggink
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Gerrie Steursma
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Lara M Kruyt
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Jan Willem Donkerbroek
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Arie M van Roon
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Anne I van Gessel
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Saskia C van de Zande
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Coby Meijer
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | | | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Joop D Lefrandt
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands.
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Lubberts S, Kruyt LM, Steggink LC, Steursma G, Nuver J, Oosting S, van Ginkel RJ, de Jong IJ, Eulenburg C, Lefrandt JD, Meijer C, Sluiter WJ, Gietema JA. Life expectancy 20 years after cisplatin-based treatment for testicular cancer (TC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4550 Background: Four decades have passed since the introduction of cisplatin-based chemotherapy for metastatic TC, providing the opportunity to evaluate very long-term survival. Although 80-90% of the patients are cured, the effect of treatment on residual life span is unknown. Aim of the study was to investigate life expectancy after TC treatment: from prolonging survival after cancer diagnosis, focus shifts to regaining a normal residual life span. Methods: Patients with metastatic TC treated with cisplatin-based chemotherapy > 20 years ago (1977 - 1996) at the University Medical Center Groningen were included. Survival status and cause of death were obtained from medical records, Netherlands Cancer Registry and general practitioners. Events were defined as death due to any cause (overall mortality) and death due to TC or TC treatment complications (TC specific mortality). Standardized mortality ratios (SMR) were calculated as ratio between observed and expected deaths, derived from the age-matched nationwide male population (Dutch Central Office of Statistics). SMRs were calculated for overall mortality, non TC specific mortality (censoring death from TC or treatment-related complications), mortality from cardiovascular disease (censoring death from other causes than cardiovascular disease (ICD-10 I0-I99)) and mortality from secondary malignancies (censoring death from other causes than secondary malignancies (ICD-10 C0-C99 excluding C62: TC)). Results: We included 321 metastatic TC patients with a median age of 28 years (range 16 - 64) at start of chemotherapy. After a median follow-up of 25 years (range 0 - 38) 106 patients died (33%). SMR for overall mortality was 4.0 (95% CI 3.6 - 4.4) and for non TC specific mortality 1.5 (95% CI 1.1 - 1.9). SMR for secondary malignancies was 1.7 (95% CI 1.0 - 2.2) and for cardiovascular diseases 1.5 (95% CI 0.7 - 2.2). Median age at death was 5-10 years lower in TC patients than expected. Conclusions: Twenty years after cisplatin-based chemotherapy, TC patients have a 50% increased risk of dying from non TC causes compared to the general population. These findings suggest that cisplatin-based treatment for TC comes at the expense of about 7.5 life years and induces early aging.
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Affiliation(s)
- Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Lara M. Kruyt
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | | | - Gerrie Steursma
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Sjoukje Oosting
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Robert J. van Ginkel
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Igle J. de Jong
- Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Christine Eulenburg
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joop D. Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Coby Meijer
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Wim J. Sluiter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
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