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.

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.

Cancer is the leading cause of disease and death worldwide and among all cancers,prostate cancer (PCA) is the second most frequently diagnosed cancer of men after lungcancer. Despite the low incidence of prostate cancer, there is a rapid increase of prostate cancer's incidence and mortality in Asian countries due to a more westernized lifestyle and high proportion of advanced stage prostate cancer.
Prostate ; Neoplasm Grading ; Bone Neoplasms

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

Purpose: To evaluate whether using flexible and navigable suction ureteral access sheath can obviate insertion of double J stent and establish the safety of overnight ureteric catheter placement as alternative following flexible ureteroscopy for kidney stones. Materials and Methods: Five hundred forty adults were prospectively enrolled across 25 centers (from April 2023 to January 2024). Patients were divided into group 1 (overnight ureteric catheter), and group 2 (double J stent). Surgeons could choose either modality as per their discretion. One-to-one propensity score-matching for age, sex, pre-stenting, Hounsfield units, stone volume and location was performed. Thirty-day computed tomography scan was done to estimate stone-free status. Results: After matching, 120 patients were included in each group. Group 1 had significantly shorter lasing, ureteroscopy, surgical time. Median day 1 loin pain score was similar (1 [1, 2] in both groups). Median postoperative stay was shorter in group 1 (0 days [0, 1] vs. 1 day [0, 2], p<0.001). One patient in group 2 required a blood transfusion. Incidence of fever was similar (5.0% vs. 0.8%).Loin/abdominal pain requiring medication occurred in one patient in group 2. Stent-related symptoms occurred in 2 patients in group 1. Three patients (2.5%) in group 1 and 2 patients (1.7%) in group 2 required readmission. Thirty-day stone-free status was higher in group 1 patients (79.2% vs. 56.7%). Conclusions In selected patients after thorough inspection to ensure no injury or residual fragments remain, placing an overnight ureteric catheter can be a safe alternative to a double J stent.

OBJECTIVES

To describe the demographics of patients undergoing supine PCNL (s-PCNL) and prone PCNL (p-PCNL) at Veterans Memorial Medical Center (VMMC) and to compare different data collected between the two approaches.

Retrospective data collection was done through chart review of patients who underwent supine and prone PCNL at VMMC from 2018 to 2022. Information collected includes patient demographics, clinical profile, stone burden and laterality, surgical technique, hospital days, complications and management.

A total of 176 cases, 132 s-PCNL and 44 p-PCNL, were included. Demographic data show no statistical difference as to age and sex. There is no statistical difference in the stone burden, stone density, and Guy’s stone scores between the two groups. There was no statistical difference in the mean operative time and stone free rates between the two groups. Mean hospital stay was 6.11 days for s-PCNL and 6.76 for p-PCNL, with significant statistical difference in favor of s-PCNL. Complication rates were 15.2% for supine PCNL and 13.6% for prone PCNL. There was no statistical significant difference in Clavien-Dindo complications between the two groups. There was no mortality reported for both groups.

There is an observed increasing trend in the number of supine PCNL versus prone PCNL from 2018 to 2022. Supine PCNL is as effective and safe as prone PCNL. Supine PCNL appears to be more beneficial in terms of hospital stay in days. However, one limitation of the study its being retrospective and collated data which is the cause of the discrepancy in sample population size between the two groups.

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in surrounding muscle or connective tissue, called fascia. Hernia is classified as inguinal, incisional, femoral, umbilical, or hiatal. The bladder may herniate in 1%–3% of the cases through the inguinal canal. A herniated bladder with calculus is a more unique condition that has only 3 reported cases. Reported here is a case of a 65-year-old male with a known case of left bladder inguinal hernia. He presented with an inguinoscrotal bulge at the left groin and severe lower urinary tract symptoms, associated with a need to squeeze his scrotum to complete his voiding. A Computed Tomography scan revealed inguinoscrotal bladder hernia, left with urinary bladder calculi, and an enlarged prostate gland. The patient underwent cystoscopy, inguinal exploration left, cystolithotomy, hernioplasty left. Inguinoscrotal hernia of the bladder is a rare pathology and often goes unrecognized in during surgical hernia repair. Preoperative identification of bladder hernia is essential to prevent iatrogenic trauma and severe complications. It is mandatory for general surgeons and urologists to keep in mind this rare condition during surgical repair of inguinal hernia.

There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.

Background: Turnaround time is an integral component of primary healthcare and is a key performance indicator of healthcare delivery. It is defined as the time patients spend during a healthcare facility visit. In this study, turnaround time is defined as the time elapsed from registration to the end of consultation. Objectives: This study aimed to determine the turnaround time of consults in the primary care system in a rural site in the Philippines, and compare turnaround time during the pre-pandemic and COVID-19 pandemic periods. Methods: This is a retrospective cohort study of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2021. Patients included in this study were chosen through random sampling. Electronic medical records (EMR) of these patients were reviewed. Turnaround time was computed electronically from time of registration to end of consultation. Descriptive statistics was used to summarize data and report turnaround time. The turnaround time before and during the pandemic was compared using an independent sample t-test (if normally distributed) or Mann Whitney U test (if not normally distributed). A p-value of <0.05 was considered statistically significant. Results: A random sample of 342 patients out of the total 45,501 patient consults seen at the rural primary healthcare facility from April 2019 to March 2021 were included in this study. The median turnaround time was 29.0 minutes (interquartile range [IQR] 68.3), with range of 0.9 to 437.2 minutes. During the pre-pandemic period, the median turnaround time of consults is 29.3 minutes (IQR 70.4) which is 1.8 minutes longer than the pandemic period which showed median turnaround time of 27.5 minutes (IQR 72.7). The difference between the two time periods was not statistically significant (P = 0.39). Conclusion The study showed that the median turnaround time of medical consults was 29.0 minutes, which was shorter by 80 minutes compared to other published Philippine studies. The turnaround time did not differ significantly in the pandemic and prepandemic period, despite new policies and systems that were implemented during the pandemic.
primary care ; electronic medical records ; pandemic ; Philippines