Adenocarcinoma represents 0.5 to 2% of all malignant tumors of the bladder, and the mucinous subtype is extremely rare as a primary vesical lesion. This is the case of a 50-year-old male who presented with dysuria with occasional hematuria, underwent cystoscopy, transurethral resection of the bladder tumor, with the subsequent diagnosis of Mucinous adenocarcinoma of the bladder. He then completed neoadjuvant chemotherapy but eventually underwent cystoprostatectomy, urethrotomy with extended bilateral pelvic lymph node dissection due to tumor progression.

Adenocarcinoma represents 0.5 to 2% of all malignant tumors of the bladder, and the mucinous subtype is extremely rare as a primary vesical lesion. The patient is a case of a 50-year-old male who initially presented with dysuria with occasional hematuria. A CT scan was done and showed bladder new growth. Cystoscopy Transurethral Resection of the bladder tumor was done revealing mucinous adenocarcinoma of the bladder. He then completed neoadjuvant chemotherapy with Pacitaxel and Cisplatin for 4 cycles, however repeat CT scan with contrast post chemotherapy showed progression of the adenocarcinoma. Due to the possibility of a primary lesion in the gastrointestinal tract, colonoscopy was performed revealing sessile serrated adenoma, as were tumor markers CA 19-9, CA 125, alpha-fetoprotein, and CEA, all of which without any abnormal results. He eventually underwent cystoprostatectomy and urethrectomy with extended bilateral pelvic lymph node dissection. The margins and lymph nodes were negative for tumor invasion. Adenocarcinoma is diagnosed mainly on histopathology and with the help of Immunohistochemistry (IHC). Once the diagnosis is confirmed, the radical surgery should be advised which could improve survival and disease progression.

OBJECTIVE: To document the VMMC Urethral Dilatation Protocol, established in Veterans MemorialMedical Center for male patients with urethral stricture who underwent urethrotomy and to determineif there is a significant difference in the International Prostate Symptom Score and Uroflowmetrystudies after urethral dilatation in male patients with urethral stricture who underwent urethrotomy. MATERIALS AND METHODS: The is a descriptive, retrospective chart review of male patients in VeteransMemorial Medical Center diagnosed with urethral strictures via voiding cystourethrogram or flexiblecystoscopy who underwent urethrotomy. A total of 24 patients were enrolled in this study, all ofwhom were post TURP patients. All patients with recurrent urethral stricture, history of trauma andpatients with infectious causes of stricture were excluded. Each patient's International ProstateSymptom Score and Uroflowmetry studies prior to urethrotomy and post urethrotomy who underwentthe VMMC urethral dilatation were collected. Median and range (Minimum-Maximum) were usedto describe the variables of the study. These variables are IPSS, peak flow rate, average flow rate,voided volume, and residual volume. RESULTS: The IPSS, was statistically lower after urethrotomy with urethral dilatation and theuroflowmetry parameters (peak flow rate, average flow rate, voided volume, and residual volume)were statistically improved after urethrotomy with urethral dilatation. CONCLUSION The Urethral Dilatation Protocol established in Veterans Memorial Medical Center andwhich is done every week for 1 month, then every 2 weeks for another 1 month, and monthly untilthere is markedly improved International Prostate Symptom Score showed that this timing may helpimprove IPSS and patient symptoms but not lessen recurrence rates.

Penile calciphylaxis is a rare penile condition associated with end-stage renal disease and is found in 1-4% of hemodialysis patients. The condition has an overall mortality of 64%. Literature has yet to provide a gold standard for the management of this condition. The first case is a 58-year-old diabetic and hypertensive on hemodialysis who presented with ulcerating lesions on the penis. The patient underwent partial penectomy. The patient contracted pneumonia during recovery and expired 3 months after the procedure. The second case is a 56-year-old diabetic with end stage renal disease on dialysis who presented with dry gangrene of the penis. He underwent partial penectomy and was sent home after recovery.

Background: The Gleason Sum derived from transrectal ultrasound guided prostate needle biopsy (TRUS-PNB) is critical in the selection of an appropriate treatment and also important in predicting the possible outcome. Scoring is therefore critical in the selection of a proper management. The concordance between prostate needle biopsy and radical prostatectomy histopathology in terms of the Gleason Sum was here in evaluated. Methods: This is a retrospective cohort where a review and analysis of 28 charts were made. All patients who underwent TRUS-PNB and subsequently radical prostatectomy were included in the study. The concordance rates between prostate needle biopsy and radical prostatectomy histopathology were elucidated. Results: With the Gleason Sum 6 upon TRUS-PNB (n=17), 9 (53.9%) matched their postoperative pathological findings, while 8 (47.0%) were upgraded to Gleason Sum 7. No finding of downgrading was observed postoperatively. Tumors graded GS7 on TRUS-PNB upon biopsy (n=11) had the best concordance; with 11 (100%) matched at radical prostatectomy. No over grading or downgrading was observed. Conclusion GS6 tumors being upgraded to GS7 tumors are still being observed. Owing the diagnosis of prostate cancer relying heavily on biopsy may still yield discordance. Though improvements with regards to biopsy technique may evolve, the usual 12 core biopsy is still being applied. With this, different factors that may predict discordance and strategies to minimize discordance still remain important for the appropriate treatment of prostate cancer.
Biopsy

OBJECTIVE: To correlate male lower urinary tract symptoms between age, quality of life scores,parameters of uroflowmetry and prostate size. PATIENTS AND METHODS: Two hundred eight males were included in this study. Uroflowmetry parameters,age, International Prostate Symptom Score (IPSS), Quality of Life (QoL) scores and prostate sizewere gathered. For correlation, distribution of age, uroflowmetry parameters and prostate size werefirst compared to IPSS. Analysis of variance was used to compare age of patients, while Kruskall-wallis test was used to compare the QoL, uroflowmetry parameters, and prostate size on each IPSSgroups. Ordinal logistic regression analysis was used to correlate IPSS to age, quality of life,uroflowmetry parameters, and prostate size both for multivariate and univariate analysis. RESULTS: There was no significant correlation between age and IPSS. However, on profile distribution,the age distribution between symptom scores were statistically similar. Qol scores were directlyproportional to IPSS. Thus, patients with a worse QoL score were more likely to have higher IPSS.Qmax scores decreased as symptom severity increased. Patients with higher Qmax scores are lesslikely to have higher IPSS scores. Voided volume was observed to decrease as IPSS severity increased,but this was not statistically significant. Patients with higher post void residual scores were morelikely to have higher IPSS. There was also no significant correlation between prostate size and IPSS. CONCLUSION There were no significant correlation between IPSS and age, voided volume and prostatesize. On the other hand, patients with a worse QoL score and a high post void residual had higherIPSS. Patients with a high Qmax, are less likely to have an elevated IPSS.

OBJECTIVE: To provide an overview on the impact of healthcare disruption by the COVID-19 pandemic to urology training programs in the Philippines. METHODS: A survey questionnaire was used in collaboration with the study done by Rosen, et al. last May 2020. Telephone survey of the study population was done determining the status of resident staffing, workload, health/wellness, and didactics. Numerical and categorical data were analyzed and descriptive statistics are provided. RESULTS: All the observations on resident time in the workplace, including assignment to teams (81%), redeployment responses (55-97%), and remote clinical work (65%) were significant. Fifty one percent of residents have decreased research load. Eighty one percent have didactics in small groups. Fifty-five percent have 1 to 2 Video-based learning/conferences per week (p=0.007) followed by those with 3-4 with 98% (p=0.120) and those with >5 with only 6% (p=0.729). For Resident health and wellness, 87% of the residents were exposed to COVID-positive patients, but only 8% of residents were COVID positive (p=0.591). Lastly, 59% of the participants do not have access to wellness programs. CONCLUSION Data from respondents revealed significant changes in the different aspects of the present study. Urology residents spent more time away from their specialties, and have been re-deployed to COVID-19 floors. Ambulatory services, conferences, educational lectures have mostly shifted to virtual platforms. Resident concerns for COVID-19 exposure have been addressed properly; however, wellness programs have not been widely available for residents. As a first national survey, the present study may give significant insights on program changes and may be used as preliminary data for future studies.
Philippines