INTRODUCTION: The goal of PCNL is to achieve a high stone-free rate while minimizing complications. Its success results from an interplay of patient, stone and renal anatomical characteristics, the access site and the level of surgical expertise. Data comparing upper versus lower calyceal PCNL as regard to efficacy and safety are limited.
OBJECTIVE: To compare the clinical efficacy and safety outcomes of upper versus lower calyceal access in patients who underwent PCNL at St. Luke's Medical Center.
METHODS: A retrospective chart review was done on patients who underwent PCNL at SLMC from January 2010-January 2015. The patients were classified based on the renal access site: Group 1 (upper calyceal) and Group 2 (lower calyceal). The stones were classified according to Guy Stone score and complications were summarized using the modified Clavien classification.
RESULTS: A total pf 91 patients underwent PCNL during the study period. Of these, only 84 patients were analyzed. Seven were excluded due to lack or incomplete postoperative imaging on follow up. Forty-one were included in Group 1, while 43 were included in Group 2. According to the Guy Stone score, the stones in Group 1 were 21(IV), 6(III), 7(II) and 6(I) while in Group 2, 18(IV), 5(III), 8(II), 12(I) (p-value=0.52) with a mean stone volume of 38.2± 44.24cm3 and 28.0± 31.04cm3 in Groups 1 and 2 respectively (p-value= 0.23). Success rate was 80.5% and 83.7% for Groups 1 and 2 (p-value=0.70), respectively and mean stone clearance rates of 98.5% and 95.8% (p-value=0.13),respectively. The mean operative time was 181.0±82.26 and 169.5±52.12mins for Groups 1 and 2 (p-value=0.451),respectively. A total of 36 complications (13 from Group 1 and 23 from Group 2) were evaluated. Fever (Grade 1) occurred in 10 (24%) and 17(39%) for Groups 1 and 2, respectively. Blood transfusion (Grade 2) was observed in 4(9%) patients and 3(7%) in Groups 1 and 2, respectively. Two patients (5%) in Group 2 required postoperative double-J sent insertion due to ureteral stone migration (Grade 3). There was no significant difference noted among the groups as regards complication rates (p-value=0.097) and length of hospital stay (p-value=0.687). There was no mortality in either group.
CONCLUSION: Based on our experience, both upper and lower calyceal access PCNL achieve equivalent efficacy and comparable safety profile in the treatment of complex renal stones.

Human ; Male ; Female ; Adult ; Blood Transfusion ; Kidney Calculi ; Kidney Calices ; Length Of Stay ; Operative Time ; Treatment Outcome ; Ureteral Calculi

OBJECTIVE: To compare the diagnostic efficacy between the transperineal and the transrectal prostate needly biopsy as the initial biopsy strategy for detection of prostate cancer.
METHODS: A total of 179 patients with PSA of 2.5-20 ng/mL who underwent initial prostate needle biopsy were included. One hundred eight (108) patients underwent transrectal prostate needle biopsy (TRUS-BX) from March to December 2014, while 71 patients underwent transperineal prostate needle biopsy (TP-BX) from January 2015- August 2016. Descriptive statistics including mean, median and percentage were used for the patient demographics. Student's t-test was used to compare continuous variables between the two groups. X2 or Fisher's exact probability tests were used for categorical variables.
RESULTS: The mean age of the patients who underwent the TP-BX and TRUS-BX were 66.10 years and 62 years respectively (p=0.0003). The mean prostate volumes were 44.10 mL and 42.39 mL (p=0.5405), while the mean PSA were 9.51 ng/mL and 9.21 ng/mL (p=0.6096) for the TP-BX and TRUS-BX,respectively. The TP-BX provided a greater overall cancer detection rate of 63.38% (45/71) compared to 35.19% (38/108) obtained from the TRUS-BX (p<0.0001). Detection of clinically significant cancer, defined as Gleason score of 7 or higher was likewise greater in the TP-BX compared to the TRUS-BX (77.78% vs 55.26%; p=0.029). Among patients with PSA values of 2.5 ng/mL-10 ng/mL, cancer was detection was significantly higher in the TP-BX group (59.09% vs 31.11% p value=0.002). Cancer detection rates in patients with PSA 10ng/mL-20ng/mL were comparable in between the two groups (70.37% vs 55.56% p value =0.309). Of the patients who had cancer in the TP-BX group, 77.77%(35/45) involved in the anterior sector, 60% (27/45) the middle sector and 48.89% (22/45) the posterior sector. Thirteen out of the 35 cancers (37.14%) detected in the TP-BX group involved exclusively the anterior sector. The most common complication was hematuria at 35.21% for TP-BX and 50% for TRUS-BX. Complications that occurred exclusively for TRUS-BX included fever (2.78%) and 1 case (0.93%) of septicemia requiring hospitalization and parenteral antibiotics. Minor perienal bruising occurred exclusively in 8.45% of the patients who underwent TP-BX.
CONCLUSION: The transperineal prostate needle biopsy should be considered as the initial biopsy strategy for the detection of prostate cancer. The manifested advantages are the following: a) The overall cancer detection rate is significantly higher, b) The detection rate of clinically significant cancer is significantly greater, c) It provides a far more superior detection of exclusive anterior zone cancers which are often under detected or undetected with the current standard TRUS-BX and d) Complications are comparable, if not fewer than the current standard TRUS-BX.

Human ; Male ; Aged ; Anti-bacterial Agents ; Biopsy ; Biopsy, Needle ; Demography ; Hematuria ; Hospitalization ; Neoplasm Grading ; Probability ; Prostatic Neoplasms ; Sepsis

OBJECTIVE: To present the authors' experience on transperineal prostate sector biopsy (TPSB) in detecting prostate cancer, in identifying both low Gleason prostate cancers as well as clinically significant prostate cancer (Gleason 7 and higher), and in determining anatomical distributions of prostate cancer in both initial and repeat biopsy settings.
METHODS: All patients from June 2014 to September 2016 who underwent TPSB, as initial biopsy or repeat biopsy after previous negative transrectal ultrasound-guided biopsy (TRUSPNB) were included. Data for each patient were collected prospectively and subjected to statistical analysis. T test was used for continuous variables while Chi square test or Fisher exact test was used for categorical variables. Multiple logistic regression models were used to identify factors predictive of a positive result.
RESULTS: A total 130 patients were included in the study, 73 had TPSB as initial biopsy and 57 as repeat biopsy after previous negative TRUSPNB. The mean patient age of the Initial Biopsy Group (IBG) was 66 years while the mean age for the Repeat Biopsy Group (RBG) was 68 years. The IBG had a lower mean serum PSA level (9.07 ng/mL for IBG and 9.59ng/mL for RBG) and smaller prostate volumes (42.9 mL for the IBG and 44.3mL for the RBG). Prostate cancer was detected in 65.8% (48/73) of the IBG and 40.4% (23/57) of RBG, of which 77.1% (37/48) and 73.9% (17/23) respectively, were clinically significant, defined as a Gleason score of ?7. Of the cancers detected in IBG, 29.2% (14/48) exclusively involved the anterior sector (based on the Ginsburg Study Group's biopsy map), while 30.4% (7/23) were conned exclusively within the anterior sector for the RBG. Increasing PSA level and lower prostate volumes were predictive of cancer detection in RBG, while only increasing PSA level was predictive of a positive result in IBG.
CONCLUSION: Transperineal prostate sector biopsy demonstrated a high prostate cancer detection rate for both the initial and repeat biopsy settings. Likewise it provides for excellent sampling of the anterior region of the prostate, as it affords a more accurate sampling of the prostate gland based on a preplanned map and template to sample areas of interests. Similarly, it detects a high proportion of patients with clinically significant prostate cancer. This technique should therefore be highly considered as a first line option for all patients in whom a prostate biopsy is warranted.

Human ; Male ; Aged ; Chi-square Distribution ; Image-guided Biopsy ; Logistic Models ; Longitudinal Studies ; Neoplasm Grading ; Prostatic Neoplasms

INTRODUCTION: One of the common risk factors in urinary tract infection is vesico-ureteral reflux. According to some studies, it is seen in 30%-50% of children and 40%-50% present with febrile urinary tract infection. The presence of moderate to severe reflux is an important risk factor in terms of acute pyelonephritis and reflux nepropathy. Investigation of children with urinary tract infection has undergone change so as to detect those who will benefit from diagnosis and treatment at the same time avoid over investigation.
OBJECTIVE: The present study aimed to determine the role of ureteral jet angle (UJA) in detecting vesicoureteral reflux (VUR) as compared to the gold standard of voiding cystourethrography (VCUG).
METHODS: A total number of 152 kidneys from 76 patients (37 female and 39 males) ages from 2 months up to 11 years old were included in this study. These patients presented with recurrent urinary tract infection as confirmed via routine urinalysis and/or urine culture and sensitivity and assessed to have vesico-ureteral reflux disease as confirmed by voiding cystourethrogram (VCUG). They were included regardless of the grade of reflux (grade I-V). Patients with urinary tract infection but negative VCUG were also included. Excluded from the study were parents with no consent, patients with neurogenic bladder disorder as cause of recurrent urinary tract infection, patients who had postoperative correction of vesico-ureteral reflux prior to ureteral jet angle sonography, patients currently taking medication for urinary tract infection and patients currently symptomatic for recurrent urinary tract infection i.e. fever,chills,dysuria. All of the participants underwent kidney, urinary bladder ultrasound with ureteral jet angle sonography and all data were collected.
RESULTS: Out of 152 kidneys, vesicoureteral reflux was seen in 91 of them (60%). Low grade reflux defined as grade I or grade II reflux was present in 32 kidneys (21%) and high grade reflux defined as grade III-V reflux was seen in 59 kidneys (39%). In both right and left kidneys, no significant difference was observed in bladder volume and expected bladder capacity (EBC) by VUR status. On the other hand, there was a significant difference observed in volume to reach reflux by VUR status of both right and left kidneys. No significant difference was observed in UJA volume, EBC, EBC% and UJA degrees by VUR status in the right kidneys. On the other hand, UJA volume, EBC and EBC% was significantly different by VUR status in the left kidneys. All AUCs were less than 0.7 even if EBC was considered. Therefore, UJA may have poor ability to classify patients correctly according to their VUR status.
CONCLUSION: Doppler flow ultrasound measurement of ureteral jet angle may be a simple and real non invasive test in children of any age but it only showed poor correlation compared to voiding cystourethrography in detecting vesicoureteral reflux. The ureteral jet angle sonography may not be a good initial diagnostic test in assessing vesicoureteral reflux due to its low sensitivity and specificity in detecting the said disease.

Human ; Male ; Female ; Child ; Child Preschool ; Infant ; Dysuria ; Kidney ; Urinalysis ; Urinary Bladder, Neurogenic ; Urinary Tract Infections ; Vesico-ureteral Reflux

OBJECTIVE: To identify and assess the available literature in evaluating the efficacy and safety of ketoconazole in preventing postoperative erection among patients who underwent penile or urethral reconstructive surgery.
METHODS: From the period of 1990 to September 2016, the investigators assessed Cochrane Central Register of Controlled Trials, EMBASE, HERDIN, and PubMed for studies evaluating the efficacy and safety of ketoconazole in preventing post operative erection among patients who underwent penile or urethral reconstructive surgery. Review authors selected articles for inclusion, extracted date and and assessed trial quality.
RESULTS: One randomized controlled study and 2 retrospective studies were included in the review. Three studies for a total of 83 patients ages 17-32 comprised the evidence for this review. All trials investigated the efficacy and safety of ketoconazole in the prevention of post operative erection. In both retrospective studies, ketoconazole had significant prevention of erection in however both of these studies were non-RCTs. In the randomized control study by DeCastro et.al.,ketoconazole had no significant difference in the prevention of post operative erection against placebo. Sixteen out of 19 patients (84%) taking ketoconazole had episodes of erection and 15 out of 18 patients in the placebo group (83%) had episodes of erection. Common side effects include nausea (9-21%) and elevated liver enzymes (0-5.3%). Other reported adverse events include feet swelling,pruritus,frequent urination and headache. Present in only 1 out of the 31 patients (3.2%) in the study of DeCastro. All these adverse events were not statistically significant.
CONCLUSION: This review demonstrated that the use of Ketoconazole in the prevention of postoperative erection remains inconclusive. Further prospective randomized controlled trials with testosterone assay will help determine the appropriate dose and its efficacy in the prevention of postoperative erections. Ketoconazole is relatively safe if target testosterone levels are achieved using the 400mg/tab TID dosing.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Headache ; Ketoconazole ; Liver ; Nausea ; Penile Erection ; Penis ; Pruritus ; Reconstructive Surgical Procedures ; Testosterone ; Urethra ; Urination

OBJECTIVE: The purpose of this study was to translate the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) into Filipino and determine its psychosometric properties mainly feasibility, internal consistency (reliability), and stability (test-retest reliability).
METHODS: This was an observational, non-interventionist study, which recruited 100 male and 100 female patients seeking consult at the Philippine General Hospital for lower urinary symptoms. The questionnaires were completed in a single visit with the exception of 20 patients who were asked to answer the questionnaire again after 2 weeks to evaluate test-retest reliability. The ICIQ-MLUTS Filipino questionnaire is a 14-item self-administered questionnaire while the ICIQ-FLUTS Filipino questionnaire is a 13-item self-administered questionnaire.
RESULTS: There was an 81% completion rate for the ICIQ-MLUTS questionnaire and 100% completion rate for the ICIQ-FLUTS questionnaire. Reliability testing revealed Cronbach's alpha coefficient of 0.949 for the ICIQ-MLUTS and 0.956 for the ICIQ-FLUTS questionnaire while test-retest reliability showed intraclass coefficient values above 0.9 for individual items of both questionnaires.
CONCLUSION: The Filipino versions of the ICIQ-MLUTS and ICIQ-FLUTS questionnaires show adequate feasibility, reliability and validity.

Human ; Male ; Female ; Hospitals, General ; Lower Urinary Tract Symptoms ; Referral And Consultation ; Reproducibility Of Results ; Surveys And Questionnaires ; Translating ; Urinary Incontinence

OBJECTIVE: Precise entry to the upper posterior calyx is key to a successful and safe upper pole access PCNL. The surgeon's knowledge of the average skin to calyceal distance can serve as a guide to avoid inadvertent injury to both the kidney and collateral organs during the percutaneous puncture.
METHODS: The authors analyzed the radiologic images of 84 patients who underwent unenhanced 64-slice helical CT scan (Toshiba®). Skin-to-calyceal distance (SCD) to the upper posterior calyx were measured using the Vitrea® software inherent to the CT scan.
RESULTS: The mean SCDs is non-hydronephrotic kidneys were 54.9 ± 13.7 mm and 61.4 ± 12.5 mm on the right and left, respectively while in hydronephrotic kidneys, the mean SCDs were 60.3 ± 11.8 mm and 58.6 ± 13.1 mm on the right and left, respectively. There was no statistically significant difference between the right and left upper pole SCD in both groups (p = 0.84).
CONCLUSION: The mean SCD to the upper posterior calyx among Filipino adults is about 6.0 cm. By limiting the depth of the initial puncture to within the distance, the endourologist may avoid overshooting the targeted calyx, thus avoiding undue injury to the kidney or intraabdominal structures.

Human ; Male ; Female ; Adult ; Young Adult ; Kidney Calices ; Tomography, X-ray Computed ; Kidney ; Tomography, Spiral Computed ; Punctures ; Surgeons

INTRODUCTION: National annual prostatic digital rectal exam (DRE) campaign advocated by the Philippine Urological Association (PUA) started 2 decades ago in over 60 urological centers in the country. It is being used as a tool to educate Filipinos regarding benign and malignant prostate diseases. However, after each campaign, most patients were lost to follow-up leading to delay in diagnosis and low adherence to medications.
OBJECTIVE: To evaluate the effect of short message service (SMS) in the adherence to follow-up of participants after a campaign.
METHODS: The investigators enrolled 126 participants aged 40 years old and above with significant LUTS and/or a prostate cancer suspect, in a two arm, parallel, randomized controlled pilot study at the Jose R. Reyes Memorial Medical Center (center with the most number of participants annually in the Philippines). Participants received daily SMS text messages for 3 days (n = 63) or usual care (n = 63). The primary outcome was follow-up at the outpatient clinic within 1 month after campaign. The investigators used Epi Info version 7 to analyze the data.
RESULTS: Among participants receiving SMS, 21/63 (33.3%) returned, compared to 5/63 (7.94%) in the control group. The relative risk [RR] = 4.2, odds ratio = 5.8 and uncorrected chi-square (X2) = 12.4, at 95% confidence inetrval; p = 0.000429).
CONCLUSION: This pilot study illustrated the feasibility of using SMS reminder among Filipino national prostatic DRE participants to improve adherence to follow-up. However, further research needs to be done to investigate the impact on adherence to medications and delay in diagnosis.

Human ; Male ; Middle Aged ; Text Messaging ; Odds Ratio ; Risk ; Control Groups ; Pilot Projects ; Arm ; Prostatic Diseases ; Prostatic Neoplasms ; Ambulatory Care Facilities

OBJECTIVE: National prostatic digital rectal examination (DRE) advocated by the Philippine Urological Association (PUA) started 2 decades ago in the advent of prostate specific antigen (PSA) screening. It is an effective campaign in promoting prostate health awareness among Filipinos. The aim of this research was to describe and correlate the demographics, clinical profile and prostatic physical findings examined by urologists in over 60 centers in the country.
METHODS: This study was an analytical cross-sectional study involving the participants of the 2013-2015 National DRE campaign. The data were retrieved from the PUA secretariat using a convenience-sampling method on completed forms. The data were correlated using a non-parametric measure of statistical dependence between two variables.
RESULTS: The total number of participants was continuously rising [n=978 (2013), n=2052 (2017) and n=2792 (2015)] having 60-70% newly diagnosed cases annually. Participants were mostly on their 6th decade of life, mostly employed, married and an educational attainment of secondary level. The most predominant symptom was nocturia followed by frequency, incomplete emptying and weak stream. The usual prostate size was between 21-30 grams mostly with doughy consistency, nodular and tender. The mean age of having clinically benign prostate enlargement was noted to be consistent at the age of 61 while that of a prostate cancer suspect ranged from 63-69 years old.
CONCLUSION: Filipinos have similar predominant signs and symptoms of prostate disease as compared to Malays, Chinese and Indians. Clinical findings of prostate diseases correlated well with age, prostate size and consistency.

Human ; Male ; Prostate-specific Antigen ; Digital Rectal Examination ; Nocturia ; Urologists ; Malaysia ; Philippines ; Rivers ; Prostatic Neoplasms ; Prostatic Hyperplasia ; Demography

INTRODUCTION: Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).
OBJECTIVE: The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.
METHODS: On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.
RESULTS: From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).
CONCLUSION: Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.

Human ; Male ; Aged ; Middle Aged ; Adult ; Urinary Retention ; Prostatic Hyperplasia ; Edetic Acid ; Transurethral Resection Of Prostate ; Urinary Catheterization ; Lower Urinary Tract Symptoms ; Urination