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

Human ; Male ; Prostatic Neoplasms ; Genital Neoplasms, Male ; Neoplasms ; Risk Reduction Behavior ; Life Style ; Phytochemicals ; Antineoplastic Agents

OBJECTIVE: Endoscopic surgery is one of the most common minimally invasive surgical techniques applied in the field of urology. The authors developed a mechanical adaptor for commercially available penlight-type LED light that can be used in common endoscopic procedures in urology.

MATERIALS AND METHODS: A four-piece light adaptor device made from medical-grade aluminum steel was crafted and functions as an adaptor for penlight-type LED light in one end and an endoscopic telescope on the other end. In order to determine its function and quality, it was compared to the conventional light source machine used in most endoscopic procedures. The specification of both light sources were compared in terms of light intensity and colour temperature through a light meter. This device was applied clinically by using it in a series of endoscopic procedures.

RESULTS: Application of the device in the endoscopic surgical procedures showed that it functioned well and appropriately. It was able to complete a full course of each operation undertaken.

CONCLUSION: This original an innovative device offers an alternative to the conventional light source equipment available commercially. Based on the authors experience we recommend the use of this adaptor for common endoscopic procedures done in minimally invasive surgery.

Human ; Male ; Female ; Endoscopy ; General Surgery ; Urology ; Minimally Invasive Surgical Procedures ; Inventions ; light ; Equipment and Supplies

OBJECTIVE: To determine the validity of NMP-22 (Bladder Check Protein Test Pack Kit) in the diagnosis of bladder cancer.

MATERIALS: From May 1, 2009 to October 31, 2009 all patients with bladder mass by ultrasound, IVP or CT scan from three different urology training institutions were enrolled in this prospective study. These patients underwent urine cytology and NMP-22 qualitative assay. The diagnosis determined from the cytoscopic and histopathologic findings from CTURBT was accepted as the gold standard.

RESULTS: Thirty nine subjects were enrolled in this study, whom of 31 patients were diagnosed of malignancy and 8 were benign in pathology. The sensitivity of urine cytology, NMP-22 assay and cytoscopy was 34.6%, 96.8% and 92.3% respectively and the specificity was 37.5% for NMP-22 and 66.1% for the cytoscopy.

CONCLUSION: The result of this study suggests that NMP-22 is a very sensitive test, however is less specific in identifying bladder cancer.

Human ; Male ; Female ; Middle Aged ; Neoplasms ; Urologic Neoplasms ; Urinary Bladder Neoplasms-cytology, diagnosis, pathology ; nuclear matrix protein 22 ; ultrasonography ; Tomography Scanners, X-Ray Computed ; ;

OBJECTIVE: This study aimed to determine clinical characteristics that are associated with tuberculosis orchitis in patients who present with a testicular mass.

MATERIALS AND METHODS: This is an analytic retrospective cohort study of patients who underwent radical orchiectomy for a possible testicular malignancy based on a testicular mass from 2005 to 2009. The following data were derived from a review of the patient's charts: patient age, laterality of the disease, duration of symptoms, concomitant extra-testicular tuberculosis (TB), pre-operative anti-TB treatment received, pertinent pre-operative physical findings, pertinent diagnostics done pre-operatively, and intra-operative findings.

RESULTS: The prevalence of testicular tuberculosis in persons who underwent radical orchiectomy for a scrotal mass is 31.8%. TB orchitis occurs more often in younger patients, those who have had tuberculosis in the past, or have received treatment, those with larger testicular masses, those with scrotal skin sinus and tenderness or swelling, tunica, vaginalis invasion, scrotal skin invasion, and epididymal enlargement, and those with cheesy substance noted in intraoperative findings. There were no significant differences between testicular tuberculosis and testicular tumor in terms of ultrasound findings.

CONCLUSION: Testicular tuberculosis is prevalent among patients who underwent radical orchiectomy due to a scrotal mass. Several clinical characteristics preoperatively and intraoperatively may predict TB orchitis in these patients.

Human ; Male ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Orchitis ; Testicular Diseases ; Male Urogenital Diseases ; Orchiectomy ; Tuberculosis-history

OBJECTIVE: This study aimed to determine the effects of garlic (Allium sativum) on N-Methyl-N-Nitrosourea induced transitional carcinoma in Wistar rats.

METHODOLOGY: Transitional cell carcinoma was induced in thirty male, age-matched Wistar rats (45-50 days old) through intravesical instillation of 0.1mL of N-Methyl-N-Nitrosourea. They were divided into five treatment groups (0.1 mL of NSS; 0.1 mL of Mitomycin C; 0.1 mL of aqueous garlic extract in 10 mg/kg, 20 mg/kg, and 40 mg/kg given daily for the duration of the study); with one rat sacrificed every week (starting two weeks from tumor induction) until all rats were sacrificed after one month. The urinary bladders of the rats were subjected to histopathologic examination by a single veterinary pathologist. One-way ANOVA was used to compare mitotic index, papillomatous growth and vascularization of the specimens at Day 14 (baseline), 21 and 28. A P-value of less than 0.05 was used to detect significant difference.

RESULTS: Statistical analysis comparing mitotic index, papillomatous growth and vascularization showed no significant difference in the indices between the five treatment groups. It can be seen through that the P-value (0.144) for papillomatous growth was the smallest, which may indicate a trend towards a decrease in tumor growth at Day 28 for Mitomycin C and Garlic 40 mg/kg.

CONCLUSIONS: This preliminary study showed a favorable trend towards decreased papillomatous growth in the MNU induced rat bladder carcinoma treated with aqueous extract of Garlic (Allium sativum) at a higher dose and longer duration of time.

Animal ; Male ; Carcinoma, Transitional Cell ; Neoplasms ; Carcinoma ; Garlic ; Plants ; Urinary Bladder ; Rats, Wistar ; rats ; Plant Extracts ; Methylnitrosourea ; Nitrosourea Compounds

OBJECTIVES: To compare the effect of Tramadol, Tramadol/HNBB combination and Tramadol/Alfuzosine combination in the relief of renal colic.

MATERIALS AND METHODS: A total of 82 patients diagnosed with renal colic from May to October 2009 were included in the study. The patients were divided into three groups: Group I (n=27) was given Tramadol (50 mg/capsule orally) only, Group II (n=28) was given Tramadol and Hyoscine-N-Butylbromide (10 mg/tablet orally) and Group III was given Tramadol and Alfuzosine (10 mg/tablet orally). Pain was evaluated using the Visual Analog Scale pre-treatment and post-treatment.

RESULTS: The Visual Analog Scale scores for all groups showed improvement after treatment. The average difference in Visual Analog Scale for Group I was 3.148, Group II was 3.444, and Group III was 3.429. A significant difference was seen in all treatment groups. ANOVA was used to compare the differences between the three treatments. All treatments had comparable results, therefore, no significant difference was seen in the effect of the three treatments.

CONCLUSION: Relief of renal colic was achieved in all groups as seen in a decrease in the Visual Analog Scale Score after giving of treatment, however, the differences for each treatment group was not statistically significant.

Human ; Male ; Female ; Adolescent ; Child ; Renal Colic-Signs and Symptoms, treatment, management ; Visual Analog Scale-Diagnostic Techniques and Procedures ; Tramadol ; Butylscopolammonium Bromide