OBJECTIVE: Bladder autoaugmentation with detrusorectomy is done to improve bladder capacity and compliance in neurogenic bladders, to achieve constant low bladder pressure, preventing sequelae such as renal failure. Some reports discourage its application however citing that effects are short term and failure rates are high. We compared the pre and post-operative urodynamic profile of high risk patients undergoing autoaugmentation or enterocystoplasty to determine if it can still be used as a treatment option for neurogenic bladders.

MATERIALS AND METHODS: A retrospective study using the database of our spina bifida foundation was performed. Out of 382 patients, 45 underwent augmentation cystoplasty. Twenty seven (27) had followed evaluation protocol and were included in the study. The median age was 8.6 years at the time of surgery and the median years of follow up was 3.5 years. Urodynamic parameters, as well as symptom and bladder/sphincter profiles, pre- and post-operatively were compared between the two groups.

RESULTS: In the autoaugmentation group there was a 42.45% mean increase in capacity, and mean increase in compliance of 181.1% versus a 190.3% increase in capacity, and 479% increase in compliance in the enterocystoplasty group. The difference is statistically significant. There was no difference in the end filling pressure, leak point pressures, reflux, number of postoperative UTIs and incontinence. One patient in the autoaugmentation needed redo with an enterocystoplasty. Complication rates were comparable in both groups.

CONCLUSION: Autoaugmentation cystoplasty is still a viable option for surgical management of neurogenic bladders. Our data showed that in patients who underwent detrusorectomy, there was improvement of urodynamic parameters, bladder and upper tract profiles, UTIs and incontinence, which were comparable to the gold standard.

Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Urinary Bladder, Neurogenic

OBJECTIVE: The detection rate of the current standard systematic 12 core transrectal ultrasound (TRUS)guided prostate biopsy remains low despite numerous modifications of the technique. This non-randomized experimental study evaluated the accuracy of standard TRUS-guided systematic prostatebiopsy as performed by selected urologists in obtaining samples representative of the peripheral zoneof the prostate, by analyzing virtual biopsies performed on a prostate phantom model. MATERIALS AND METHODS: Thirty (30) urologists (26 consultants and 4 senior residents) were invited toperform two consecutive simulation TRUS guided 12-core biopsies on a phantom prostate model.The task was to hit twelve equal sized spherical targets which would correspond to the lateral andextreme lateral areas of the base, mid gland and apex of the peripheral zone of the phantom prostate,which would represent the usual biopsy technique. Degree of agreement (kappa) was computed.Eight (8) operators had below satisfactory kappa values and were excluded from the succeedinganalysis. Accuracy was calculated by dividing the number of accurately hit targets by the number ofvirtual cores (12). Data were encoded in MS Excel and Stata MP v.14 was used for data analysis. RESULTS: Overall, the mean accuracy was 63.17% and median accuracy was 60% (95% CI: 49.2-65.15)for the 22 operators included in the study. The lateral regions, particularly the midgland (95.8%-100% accuracy) were the most frequently biopsied areas and were often resampled. The targets at theprostatic base were missed by most operators (36.05% accuracy). CONCLUSION Systematic TRUS guided prostate biopsy, in the manner that it is performed, has itsinherent flaws, compounded by limitations in imaging capability and intra-operator variabilityresulting in low accuracy rates. A shift to newer prostate biopsy technique and methodologies withsignificantly higher accuracy rates is recommended.

: Transurethral incision of ureterocele (TUI-U) is a simple, quick, less invasive, and less expensive,and an effective procedure for the management of ureteroceles. Several studies have already shownits utility for primary management of ureteroceles but it has also been associated with the need foradditional surgery. The authors reviewed charts of patients from their database to describe the outcomesof TUI-U done in ureteroceles associated with the upper pole moiety of a duplex system. They alsolooked into preoperative patient characteristics and post TUI-U outcomes that could influence theneed for subsequent surgeries. MATERIALS AND METHODS: The authors identified patients from their duplex system database who presentedwith a ureterocele and underwent TUI-U. They reviewed the patient records of 25 patients who wereincluded in the study to determine the outcomes of TUI-U in duplex system ureteroceles. Chi squareand Mann Whitney U tests were used to determine whether preoperative patient features and postTUI-U outcomes were associated with secondary surgery. RESULTS: Out of 65 patients who had duplex system ureteroceles, 25 patients (38.4%) underwent TUI-U at a mean age of 1.51 years old. TUI-U alone was successful in improving the prevalent signs andsymptoms of 15 patients (60%) in this group, while 10 patients (40%) had to undergo subsequentsurgical procedures. Breakthrough urinary tract infection (UTI) post TUI-U was the only patientfactor noted to be significantly associated with a secondary surgery for duplex system ureterocele(p=0.027). CONCLUSION TUI-U as primary treatment for duplex system ureteroceles is not yet widely accepteddue to reported rates of morbidities and need for secondary surgery. Present data however show thatTUI-U can be used as a primary procedure and even as a definitive procedure for this subset ofpatients with remarkable results in terms of symptoms resolution and improvement of upper tract profiles.

OBJECTIVE

This study compared the demographics, clinical profile, treatment, and outcomes of retinoblastoma patients seen at medical institutions in the Philippines between two time periods: 2010 to 2015 and 2016 to 2020.

METHODS

This was a multicenter, analytical, cohort study using review of medical charts and databases of retinoblastoma patients seen in 11 medical institutions from 2010 to 2020.

RESULTS

There were 636 patients (821 eyes) included in this study: 330 patients were seen in 2010 to 2015 while 306 in 2016 to 2020. More cases per annum were seen in the latter timeline. The number of patients with unilateral disease was not significantly different between the two time periods (p=0.51). Age at onset of symptom, age at initial consultation, and delay in consult were also not significantly different between the two time periods (p > 0.05). Patients had significantly different distributions of intraocular grades (p < 0.0001) and systemic staging (p < 0.0001) between the two time periods. Enucleation was the most common surgical treatment performed in both timelines. There was significant difference in the status of patients based on the need for systemic chemotherapy (p < 0.01). There was significant difference in outcome between the two time periods, including the proportions of living and deceased patients.

CONCLUSION

This study compared the most comprehensive data on retinoblastoma patients in the country. There was no improvement in early health seeking behavior based on similar age at initial consult and delay in consult. Enucleation remained the most common treatment mode as opposed to chemotherapy due to similar percentage of patients with unilateral disease, an indication for enucleation rather than chemotherapy.

Human ; Retinoblastoma ; Philippines ; Epidemiology ; Treatment ; Therapeutics