OBJECTIVE: Since its introduction in the Philippines in 2001, low dose rate brachytherapy (permanent I-125 prostate seed implant) has become one of the widely utilized modality for the treatment of localized prostate cancer. This study aimed to evaluate the long-term clinical outcomes of low dose rate prostate brachytherapy (Permanent I-125 Prostate Seed Implant) in terms of overall survival (OS), disease specific survival (DSS), biochemical no evidence of disease (BNED), complications and mortality.

MATERIALS AND METHODS: Two hundred and two consecutive patients who underwent permanent I-125 prostate seed implant from April 2002 to December 2012 were included in this study. The details of all patients were derived from the database of a single urologist. The median follow up is 6.3 years. Kaplan-Meier curves were used to evaluate overall survival, prostate cancer specific survival and biochemical no evidence of disease (defined by the ASTRO criteria) across all disease risks. Treatment-related complications and causes of mortality were also reviewed.

RESULTS: The 11-year overall survival and disease-specific survival rates were 89.1% and 98%, respectively. The biochemical no evidence of disease was 82.7%. Log rank testing showed that survival in terms of OS, DSS, and BNED did not differ significantly regardless of risk stratification into low, moderate and high risk groups. The treatment-related morbidity rate for this series was 5.4%.

CONCLUSION: Brachytherapy is an effective treatment for localized prostate cancer with favorable long term survival results, durable biochemical outcomes, and minimal toxicity.

Human ; Male ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Neoplasms ; Prostatic Neoplasms ; Brachytherapy ; Prosthesis Implantation

OBJECTIVE: Neurogenic bladder dysfunction (NBD) in myelomeningocele (MMC) remains a major cause of renal decline. We evaluate the initial presentation, ultrasonographic, urodynamic and VCUG findings in search of indicators that can guide in early decisions in treatment to avoid poor long-term outcomes.

MATERIALS AND METHODS: From 1989 to 2013, 178 patients with neurogenic bladder due to MMC had records accessible for review. The median follow up was 10.4 years (0.9 - 25.0). Parameters reviewed were: patients' initial presentation; Ultrasonography: hydronephrosis grade and bilaterality, bladder wall thickness, and kidney size; Urodynamics: compliance, Detrusor Leak Point Pressure (DLPP), bladder activity and sphincter synergy; VCUG: grade of reflux, bladder pattern, and bladder neck appearance. Endpoints to which all parameters were compared were: 1. need for surgery, 2. continence 3. renal status, and 4. follow-up urodynamics

RESULTS: Recurrent UTI at presentation was associated with 3.1 times [OR = 3.1 (95% CI: 1.3 - 8.5)] need for surgery and incontinence at presentation was 11 times [OR=11.0 (95% CI: 3.8 - 33.4)] more likely to be incontinent in the long term. Hydronephrosis was associated with 4.4 times [OR= 4.4 (95% CI: 1.3 - 19.0)] risk for renal deterioration and 6 times [OR = 6.3, (95% CI: 3.8- 14.7)] need for surgery. Those with thickened bladder were 6 times [0R=6.0 (95% CI: 2.9 - 12.5)] more likely to have needed surgery. Patients with urodynamic findings of low compliance are 2.7 times [OR 2.7(95% CI: 1.2 - 6.3)] more likely to have needed surgery and high DLLP on initial consultation are 5.6 times [OR=5.6 (95% CI: 1.2 - 51.6)] more likely to have renal deterioration and 2.1 times [OR 2.1(95% CI: 1.1 - 4.4)] more likely needing surgery. On VCUG, those with "Christmas tree" pattern of bladder have 90% [0R=0.9 (95% CI: 0.01 - 0.70)] more risk for renal deterioration, 5 [0R=5 (95% CI: 2.5 - 10.2)] times more likely to need surgery and 70% [0R=0.7 (95% CI: 0.1 - 0.9)] more likely to have urodynamic deterioration. Finally, reflux, specifically bilateral, was associated with 4 times [OR = 4.0 (95% CI: 1.2 - 14.3)] risk renal deterioration as compared to those with no reflux findings and 9.6 times [OR=9.6 (95% CI: 4.1 - 23.8)] more likely to need surgery, while high-grade reflux had 90% more risk [OR = 0.9 (95% CI: 0.1 - 0.8)] to have urodynamic deterioration.

CONCLUSIONS: Prognostication early in the course of NBD in MMC is possible. It is recommended that patients with risk factors for deterioration be provided a more intensive regimen of treatment and follow-up to prevent further morbidity.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Urinary Bladder, Neurogenic ; Meningomyelocele

INTRODUCTION: Retroperitoneal laparoscopic (RPL) urologic surgery offers comparable surgical and functional outcomes to the traditional transperitoneal approach, with the advantage of circumventing the need to enter the intraabdominal space. This precludes the necessity to encounter small intestinal and colonic segments, encounter abdominal adhesions, and mobilize adjacent organs, translating to better peri-operative and post-operative conditions. However, RPL demands a strong knowledge of the retroperitoneal anatomy coupled with a level of laparoscopic dexterity, this results in a steep learning curve. Unfortunately, the evidence on the learning curve for RPL is diverse and scarce. The aim of this systematic review was to consolidate the available literature and determine the minimum required number of cases to efficiently and safely perform RPL. METHODS: This is a systematic review of the literature via PubMed, EBSCO and Science Direct of all studies published since 2000 to 2019. The search was conducted by combining the following terms, “Retroperitoneoscopy”, “Retroperitoneoscopic”, “posterior laparoscopy”, “Learning”, “Nephrectomy”, “Adrenalectomy”, and “Ureterolithotomy”. Outcomes of interest were learning curve, mean operative time, mean intra-operative blood loss and mean hospital stay. RESULTS: After the screening phase and application of the eligibility and exclusion criteria, the review included a total of 6 studies on the learning curve for RPL. The learning curve for retroperitoneoscopic adrenalectomy was 40 cases and 24 to 42 cases, based on the evidence from Uitert, et al. (2016) and Vrielink, et al. (2017), respectively. For retroperitoneoscopic nephrectomy, the minimum required number of cases is 30 – 70, based on the studies by Pal, et al. (2017), Zhu, et al. (2018) and Tokodai, et al. (2013). Ercil, et al. (2014) demonstrated the learning curve for retroperitoneoscpic ureterolithotomy to be at 30 cases. Review of each literature showed that completion of the learning curves translated to better peri-operative and post-operative conditions (i.e. shorter operative time, lesser intra-operative blood loss, shorter hospital stay). Overall, the evidence in this review suggests that for posterior retroperitoneal laparoscopy, a mean learning curve of 31 to 56 cases is required to safely and efficiently perform the procedure. CONCLUSION Retroperitoneal laparoscopic surgery is a valid alternative to the traditional transperitoneal approach. It offers comparable anatomic and functional results, albeit better peri-operative and post-operative outcomes. However, its performance requires a strong knowledge and familiarity of working within the retroperitoneum which can be achieved through progressive experience in RPL. The evidence consolidated by this review suggests a learning curve of 31 to 56 cases prior to effectively performing the procedure.

: It has been proposed that Metabolic Syndrome causes an inadvertent lowering of PSA levels in affected individuals. OBJECTIVE: This study aimed to determine the effect of metabolic syndrome on the serum PSA level. METHODS: Literature search was done using MEDLINE and Cochrane databases. The primary outcome measure was serum prostate-specific antigen (PSA) levels. Secondary outcome measures included prostate volume, plasma volume, and PSA mass density. Mean differences were computed using Review Manager 5.3 software. RESULTS: There were six articles available for analysis with a total of 33,775 in metabolic syndrome group (MS) and 70,305 in non-metabolic syndrome group (NM). Overall, there was no significant difference between the PSA levels between MS and NM group. The prostate and plasma volume were significantly higher in the MS compared with NM, having mean difference of 2.95 mL (95% CI, 1.41 to 4.49) and 162.68 mL (95% CI, 120.24 to 205.11), respectively. However, there were no significant difference in the PSA mass density between metabolic and non-metabolic syndrome. CONCLUSION Metabolic syndrome does not affect PSA levels and PSA mass density, despite increase in hemodilution.