Recently, the global endourology scene has witnessed a resurgence of interest in supine PCNL (sPCNL). The number of urologists who are attracted to this “simplified method” of PCNL is growing and its promoters are suggesting to abandon the standard prone approach. Debates on the two positions have become commonplace in endourology scientific meetings. The advocates consistently emphasize that when compared to the prone position, sPCNL has multiple advantages for the surgeon, the anesthesia team and the patient. In spite of these, it is evident that many still favor prone PCNL (pPCNL) because of its time-tested proven efficacy and safety. In fact, up to this present day, majority of PCNLs are still done in the prone position. This review article intends to analyze the “current state of affairs” of the two PCNL positions, describing their advantages and disadvantages. Presently, applying the principles of “what is safe and efficacious in one’s hands” dictates the choice of which technique is utilized to treat a patient. Conversely, it is more clinically sound if this choice was made instead, in consideration of, the interplay of the following factors such as the patient’s clinical demographics, the anatomical features of the renal collecting system, the stone burden and characteristics and ultimately, the physician’s training, skills and experience.
Nephrolithotomy, Percutaneous

OBJECTIVE: This study aims to describe the demographics, clinical characteristics of patients, and the sensitivity and specifity of the clinical, laboratory, radiologic, diagnostic parameters in detecting histopathologically-proven urinary tract involvement in primary colorectal cancer patients referred to the urology service in the Philippine General Hospital. METHODS: This was a retrospective, cross-sectional study. The study included patients referred to the Division of Urology from the Division of Colon, Rectal and Anal Surgery January 1, 2018 to December 31, 2018. All patients diagnosed with colorectal malignancy and referred to the Urology service were included in the study, including their cystoscopy, axial tomography, CEA and symptom assessment scores. RESULTS: Fifty-eight patients were included in the study and, 43% were rectal cancers and 33% were sigmoid cancers. Sensitivities and specificities were as follows. Symptoms 40%, 84%, Cystoscopy, 45%, 100%; Axial tomography 75%, 79%. Surgical involvement correlated with histopathologic involvement with a specificity of 52%. CEA did not discriminate between cohorts of positive or negative involvement. CONCLUSION Cystoscopy, axial tomography and symptom assessment had high positive predictive values. All diagnostics had low negative predictive values when taken in isolation. Surgical assessment correlated with histopathologic findings in half of the population. CEA did not discriminate between those with surgical involvement and those without. A multi-modality assessment strengthens detection of surgical involvement preoperatively.
Cystoscopy ; Colorectal Neoplasms ; Colonic Neoplasms ; Diagnostic Tests, Routine

: The current standard in the management of large burden renal stones is conventional percutaneous nephrolithotomy. Mini-percutaneous nephrolithotomy (mini-PCNL) is a procedure developed to decrease complications of standard PCNL by decreasing the size of access. Recent studies have shown high stone free rates with minimal complications in utilizing mini-PCNL in larger stones. OBJECTIVE: This study aims to assess the safety and efficacy of mini-PCNL for stones with sizes 2 cm and above versus standard PCNL. METHODS: This is a meta-analysis comparing mini-PCNL and standard PCNL in the management of renal stones 2 cm and above. A PUBMED search was done to acquire randomized controlled trials (RCTs), prospective and retrospective studies of mini-PCNL and standard PCNL assessing large burden renal stones, defined as 2 cm and above. Two authors independently assessed the studies for selection. Comparison of mini-PCNL and standard PCNL was done according to following parameters: stone-free rate, operative time, postoperative decrease in hemoglobin levels, length of hospital stay, rate of transfusion, occurrence of fever, postoperative pain scores, and occurrence of urine leakage. RESULTS: Results of this meta-analysis showed that standard percutaneous nephrolithotomy has an advantage over mini percutaneous nephrolithotomy only in terms of having a shorter operative time for larger stones (MD: 8.44 min, 95% CI 6.36 – 10.52 min, p < 0.00001). No difference was found in the outcomes of postoperative pain scores (MD 0.19 VAS score, %CI 0.16 – 0.54, p = 0.29), occurrence of postoperative fever (OR 0.33, 95% CI 0.18 – 0.61, p = 0.06) and the stone-free rate (OR 0.97, 95% CI 0.67 – 1.41, p = 0.88). Mini-percutaneous nephrolithotomy has advantage over standard percutaneous nephrolithotomy for large-burden stones in terms of shorter length of postoperative hospital stay (MD 1.44 day, 95% CI 1.22-1.66, P <0.00001), lower hemoglobin drop (MD 0.48 mg/dl, 95% CI 0.39–0.66, p < 0.00001), lower rate of transfusion (OR 0.40, 95% CI 0.20 – 0.99, p = 0.01), urine leakage (OR 0.11, 95% CI 0.03 – 0.39, p = 0.0008) and an overall lower occurrence of complications (OR 0.42, 95% CI 0.28 – 0.62, p < 0.0001). CONCLUSION Mini-percutaneous nephrolithotomy is a safe and effective intervention in large-burden stones 2 cm in size and above.
Nephrolithotomy, Percutaneous

OBJECTIVE: Transrectal ultrasound-guided prostate biopsy (TRUSPBx) is the recommended method for the histopathologic confirmation of prostate cancer. However, the overall cancer detection rate is low; hence, patients are potentially exposed to multiple biopsies and their attendant morbidity. Multiparametric MRI of the prostate followed by MRI-Ultrasound fusion-guided prostate biopsy (FBx) is an emerging diagnostic pathway that has been established and recommended in men with a persistently elevated PSA despite a previous negative biopsy. However, evidence regarding its value in the biopsy-naïve setting is scarce. The objective is to compare the diagnostic accuracy of MRI fusion-guided prostate biopsy against TRUSPBx in biopsy-naïve men. METHODS: This is a retrospective cohort study involving biopsy-naïve men with a PSA of 3 to 20 ng/ml. Primary outcomes of the study include overall cancer detection rate (CDR) and detection of clinically-significant prostate cancer (csPCa). Subgroup analyses were performed based on PSA level and prostate volume. Independent t-test, Mann Whitney U test and Chi square test were used in the statistical analysis. RESULTS: A total of 185 biopsy-naïve men with a PSA level of 3 – 20 ng/mL were included in the study. Median pre-biopsy PSA level was 7.07 ng/mL (5.06 – 11.0) and 9.02 ng/mL (5.8 – 13.8) in the FBx arm and TRUS-guided biopsy arm, respectively. Ninety-nine (n=99; 53%) underwent MP-MRI of the prostate followed by MRI fusion-guided prostate biopsy and eighty-six (n=86; 46%) underwent the standard TRUS-guided prostate biopsy. Compared to TRUSPBx, FBx significantly detected more prostate cancer (CDR: 68% vs 30%, p<0.0001) and csPCa (46% vs 22%, p=0.001). The diagnostic yield of FBx was distinctly superior in the subgroup of men with a PSA of 4 – 10 ng/mL (CDR: 64% vs 7%, p<0.0001; csPCa: 43% vs 2%, p<0.0001) and a prostate volume of <40grams (CDR: 82% vs 36%, p<0.0001; csPCa: 53% vs 21%, p=0.006). CONCLUSION Compared to the current standard, the diagnostic yield of MRI fusion-guided prostate biopsy is significantly better in biopsy-naïve men. FBx detected more men with prostate cancer, with a higher proportion of men having clinically-significant disease. This advantage is strongly evident in men with a PSA level of 4 – 10 ng/mL and an average prostate volume of 40 grams. Hence, Multiparametric MRI of the prostate followed by MRI fusion-guided prostate biopsy is an effective first-line diagnostic modality for prostate cancer in men presenting with elevated PSA levels.
Male ; Image-Guided Biopsy ; Prostatic Neoplasms

OBJECTIVE: To compare the value of intraoperative stone culture (IOSC) and intraoperative pelvic urine culture (IOPUC) versus pre-operative urine culture (POBUC) in the early detection of systemic inflammatory response syndrome (SIRS) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: This is a prospective clinical study which includes all adult patients undergoing PCNL. All patients who were operated on should have a negative preoperative urine culture (POBUC) results. Intraoperative pelvic urine culture (IOPUC) and stone culture (IOSC) were extracted and results were interpreted if they were contributory in acquiring SIRS post operatively. RESULTS: The demographics of each patient such as age, sex, having diabetes, laterality, location of calculi had no correlation to the development of SIRS. Patients with positive IOPUC and IOSC results yielded a significant value with odds of having SIRS 4.71 and 13.74, respectively. CONCLUSION In the study, all patients underwent PCNL with negative preoperative urine culture findings. Having intraoperative cultures, IOPUC and IOSC, can definitely help predict the occurrence of SIRS and ultimately be one step ahead in the management of these patients to decrease overall morbidity and mortality.
Nephrolithotomy, Percutaneous ; Systemic Inflammatory Response Syndrome ; Postoperative Period

OBJECTIVE: To compare the efficacy of periprostatic nerve block (PPNB) alone versus periprostatic nerve block plus oral Tramadol+Paracetamol Tablet for pain control during and after transrectal ultrasound-guided (TRUS) biopsy of the prostate gland. METHODS: This was a double-blind, placebo-controlled randomized clinical trial. The authors randomized 40 male patients each to either PPNB or PPNB plus oral tramadol and paracetamol (37.5mg/325mg) an hour prior to prostate biopsy. A ten-point visual analog scale was used to measure pain intensity and was recorded upon insertion of the ultrasound probe, during the biopsy, and one hour after the procedure. RESULTS: The two groups were similar in terms of baseline characteristics. Reductions in pain scores were statistically significantly different (p<.001) for each group when comparing pain from at point of insertion of the probe versus during biopsy and versus one-hour post-operatively. However, when comparing the two groups, the pain scores were not statistically significantly different upon insertion of the probe (p=.68), during the biopsy (p=.26) and one-hour post-operatively (p=.54). CONCLUSION Tramadol and paracetamol combination in addition to periprostatic nerve block produces pain relief similar to standard periprostatic nerve block alone.
Male ; Prostate ; Nerve Block ; Biopsy ; Ultrasonography

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: Radical prostatectomy (RP), brachytherapy, cryosurgical ablation and intensity-modulated radiotherapy (IMRT) are accepted treatment options for localized prostate cancer. The objectives of this study were to determine the overall survival (OS), disease specific survival (DSS) and biochemical no evidence of disease (BNED) rates of the patients who underwent these different treatment modalities.

MATERIALS AND METHODS: A total of 485 patients with localized prostate cancer treated with RP (n=235), brachytherapy (n=202), cryosurgical ablation (n=33), and IMRT (n=15) were identified from the database of a single urological practice. Analysis of variance (ANOVA) was used to compare means of patients. Chi-square test was used to compare percentages. Kaplan-Meier survival analysis was used to determine if the outcome parameters significantly differed according to the methods. P-values less than 0.05 indicate significant difference. All the statistical tests were performed using SPSS 20.0.

RESULTS: The OS rate after RP, brachytherapy, cryosurgical ablation and IMRT were 97.9%, 89.1%, 93.9% and 93.3%, respectively. The DSS rate was 99.6%, 98.0% and 97.0%. respectively. No mortality from prostatic cause was reported from IMRT. The BNED rate was 90.6%, 88.1%, 78.8% and 93.3%, respectively.

CONCLUSION: The overall and disease specific survival were comparable among all treatment modalities. Although radical prostatectomy and IMRT showed an overall better BNED outcomes, this advantage disappeared when the patients were analyzed according to their respective risk stratification into low, moderate and high risk group.

Human ; Male ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Neoplasms ; Prostatic Neoplasms-therapeutics, therapy ; Survival

OBJECTIVE: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP). Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon.

MATERIALS AND METHODS: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June 2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA. Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch's t-test and Fisher's exact test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference.

RESULTS: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins, P<0.001), anastomotic time (20.86 ± 0.49 vs 41.46 ± 0.58 mins, P<0.001), estimated blood loss (510.81 ±10.11 vs 623.89 ±26.60 ml, P<0.001), need for transfusion (7.89% vs 27.27%, P<0.001), number of days prior to drain removal (3.13 ± 0.05 vs 6.15 ± 0.11, P<0.001), number of days of hospital stay (3.44 ± 0.06 vs 6.36 ± 0.11, P<0.001), leakage per voiding cystourethrogram (0.88% vs 5.76%, P=0.035), number of days prior to urethral catheter removal (10.05 ± 0.12 vs 14.94 ± 0.2, P<0.001) and number of weeks to gain continence (7.05 ± 0.26 vs 12.46 ± 0.31, P<0.001). There were two cases of VUA stenosis for each of the two groups. There was no reported occurrence of pelvic infection, urinoma and acute urinary retention after catheter removal.

CONCLUSIONS: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.

Human ; Male ; Aged ; Middle Aged ; Neoplasms ; Prostatic Neoplasms ; Anastomosis, Surgical ; Prostatectomy

OBJECTIVE: The purpose of this study was to determine the efficacy of transcutaneous nerve stimulation (TENS) in the treatment of neurogenic bladdder secondary to myelomeningocele (MMC).

MATERIALS AND METHODS: A total of 14 children (7 boys and 7 girls) with neurogenic bladder secondary to MMC who were referred to our clinic between 2009 and 2011 were enrolled in the study. Urodynamic parameters including maximum bladder capacity (MBC) and detrusor leak point pressure (DLPP), maximum detrusor pressure (MDP) and bladder compliance (BC), daily incontinence score, constipation, and subjective improvement were recorded as outcome measures. After the first urodynamic session to get the baseline parameters, a 1 hour dose of TENS once a day for at least 3 months was applied at a certain dermatomal level. This was followed by another urodynamic session to assess its effects.

RESULTS: Out of 14 subjects, 11 (78.5%) had improvement in continence profile and 8 (57%) had improvement in bowel movement. Thirteen out of 14 (92%) had subjective improvements such as higher catheterized and/or voided volume, lesser bedwetting episodes, spontaneous voiding, increased sensation to void, presence of urgency to void, and frequent voiding. One subject had no subjective improvement. The difference in DLLP, MBC, MDP, and BC pre and post treatment was not statistically significant.

CONCLUSION: The efficacy of TENS in treating bladder dysfunction in patients with MMC remains uncertain. It did show slight improvement in urodynamic parameters specifically BC and MBC however, it was not statistically significant.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Transcutaneous Electric Nerve Stimulation-Treatment Outcome ; Meningomyelocele