INTRODUCTION: Varicoceles represent the most common attributable cause of primary and secondaryinfertility in the male. A number of studies have established the effect of performing varicocelectomyin order to improve semen parameters. Several techniques of varicocelectomy has been described inliterature, however, the microsurgical technique has been considered as the gold standard in doingthis procedure. OBJECTIVES: The study primarily aims to establish the effect of microsurgical varicocelectomy onpostoperative semenalysis when compared to baseline semenalysis. It also aimed to establish theimpregnation rate and the span at which impregnation occurs following varicocelectomy. Lastly, thestudy also describes the technique and modifications of microsurgical subinguinal varicoelectomyperformed by a single surgeon using an operating microscope and microdoppler throughout theprocedure. MATERIALS AND METHODS: Microsurgical subinguinal varicocelectomy was performed on 37 patients inSLMC from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade,operative time, intraoperative findings, postoperative complication, and 3-month follow-upsemenalysis results were recorded and compared. Successful impregnation of the partner and thenumber of months from the operation to the successful impregnation were also recorded. RESULTS: Three months postoperative semenalysis parameters were compared to the baselinesemenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60,postoperatively with p-value of 0.010. There was no significant difference observed in the totalcount, concentration, and percent immature forms. Eleven or 30% of patients were able tosuccessfully impregnate their partners in an average span of 9 months from the time of surgery. CONCLUSION In their experience, Microsurgical subinguinal varicocelectomy has improved the semenanalysis after 3 months with a 30% chance of impregnation at an average span of 9 months,postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomyfacilitated better identification of the testicular arteries.

Leiomyoma of the urinary bladder is not often encountered, occurring in only 0.43% of all bladder tumors. Among the known cases, patients usually present with obstructive symptoms, irritative symptoms or hematuria. This is a rare case of a 50-year-old male who was incidentally diagnosed to have a bladder mass. After cystoscopy, an open partial cystectomy was done with complete resection of the bladder mass. Final histopathology and immunochemical stains confirmed the diagnosis of leiomyoma of the urinary bladder.
Leiomyoma

: Multiparametric MRI (mpMRI) of the prostate is recently becoming more and more utilized in the detection of prostate cancer. Studies have shown that a higher PIRADS score correlated to a higher chance of obtaining a clinically significant prostate cancer but few studies have correlated PIRADS score to a specific Gleason score. OBJECTIVE: This study aimed to determine the concordance of PIRADS score to the Gleason score result of MRI ultrasound fusion-guided prostate biopsy. METHODS: All patients who had at least a PIRADS 2 lesion on mpMRI and underwent MRI ultrasound fusion-guided biopsy of the prostate from August 2018 up to November 2019 at St. Luke’s Medical Center, Global City were included in the study. An ambispective collection of data was done until the ideal sample size of greater than 100 positive lesions was obtained, in order to derive concordance rate. RESULTS: One hundred and sixty-two patients were included in the study with a total of 212 lesions analyzed. Forty three percent were benign while 57% were found to be malignant. PIRADS 2 lesions had zero high grade cancers, and the percentage steadily increased with 37.8% of PIRADS lesions considered high grade. Concordance was computed to be 0.38 showing a fair, direct concordance between PIRADS and Gleason score with significant result (p<0.05). CONCLUSION A result of PIRADS 4 or 5 lesion on mpMRI will have a higher urgency of doing a prostate biopsy and subsequent management to prevent unfavorable outcomes as opposed to PIRADS 3 lesions.

INTRODUCTION: Robot-assisted laparoscopic radical prostatectomy is now considered the gold standardtreatment of prostate adenocarcinoma in the modern world. There are two approaches to the precisedissection of seminal vesicles (anterior and posterior) during a laparoscopic radical prostatectomy,each of which with unique advantages and disadvantages. Primarily, the authors compared theintraoperative and oncological outcomes of these two approaches. Secondary objective included theestablishment of the minimum number of cases before a surgeon can enter the competent phase of thelearning curve. MATERIALS AND METHODS: Chart review was performed on 111 patients who underwent RALP from2014-2016 performed by 3 experienced robotic surgeons with interchangeability of role as consoleoperator. Two arms were developed based on the approach of seminal vesicle dissection, that is,anterior and posterior approach. Cumulative summation of the console time was performed to obtaina chart with a) negative slope-learning phase and b) positive slope-competent phase. Patients underthe competent phases were included for analysis. RESULTS: There were no significant differences in age, body mass index, prostate volume, preoperativeprostate specific antigen (PSA), gleason score and oncologic risk. Pathology was almost similar inmajority of cases under the anterior approach arm being gleason 7 (3+4) and posterior approach armbeing gleason 6 (3+3). With a p-value of <0.05, console time was significantly shorter in the posteriorapproach at 121±25.95 when compared to anterior approach at 148±30.25 minutes. The otherperioperative and postoperative outcomes were not significantly different between the groups. CONCLUSION Posterior approach has provided a shorter console time, while the overall oncologic andperioperative outcomes for both approaches were similar. The learning curve for the anterior approachis less steep than that of the posterior approach with only 14 versus 26 consecutive cases, respectively,to be able to competently perform RALP.

INTRODUCTION: The goal of PCNL is to achieve a high stone-free rate while minimizing complications. Its success results from an interplay of patient, stone and renal anatomical characteristics, the access site and the level of surgical expertise. Data comparing upper versus lower calyceal PCNL as regard to efficacy and safety are limited.
OBJECTIVE: To compare the clinical efficacy and safety outcomes of upper versus lower calyceal access in patients who underwent PCNL at St. Luke's Medical Center.
METHODS: A retrospective chart review was done on patients who underwent PCNL at SLMC from January 2010-January 2015. The patients were classified based on the renal access site: Group 1 (upper calyceal) and Group 2 (lower calyceal). The stones were classified according to Guy Stone score and complications were summarized using the modified Clavien classification.
RESULTS: A total pf 91 patients underwent PCNL during the study period. Of these, only 84 patients were analyzed. Seven were excluded due to lack or incomplete postoperative imaging on follow up. Forty-one were included in Group 1, while 43 were included in Group 2. According to the Guy Stone score, the stones in Group 1 were 21(IV), 6(III), 7(II) and 6(I) while in Group 2, 18(IV), 5(III), 8(II), 12(I) (p-value=0.52) with a mean stone volume of 38.2± 44.24cm3 and 28.0± 31.04cm3 in Groups 1 and 2 respectively (p-value= 0.23). Success rate was 80.5% and 83.7% for Groups 1 and 2 (p-value=0.70), respectively and mean stone clearance rates of 98.5% and 95.8% (p-value=0.13),respectively. The mean operative time was 181.0±82.26 and 169.5±52.12mins for Groups 1 and 2 (p-value=0.451),respectively. A total of 36 complications (13 from Group 1 and 23 from Group 2) were evaluated. Fever (Grade 1) occurred in 10 (24%) and 17(39%) for Groups 1 and 2, respectively. Blood transfusion (Grade 2) was observed in 4(9%) patients and 3(7%) in Groups 1 and 2, respectively. Two patients (5%) in Group 2 required postoperative double-J sent insertion due to ureteral stone migration (Grade 3). There was no significant difference noted among the groups as regards complication rates (p-value=0.097) and length of hospital stay (p-value=0.687). There was no mortality in either group.
CONCLUSION: Based on our experience, both upper and lower calyceal access PCNL achieve equivalent efficacy and comparable safety profile in the treatment of complex renal stones.

Human ; Male ; Female ; Adult ; Blood Transfusion ; Kidney Calculi ; Kidney Calices ; Length Of Stay ; Operative Time ; Treatment Outcome ; Ureteral Calculi