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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Human ; Renal Calculi ; Kidney Calculi

INTRODUCTION

Prostate cancer, a significant male health concern (ASR: 29.3/100,000), demands accurate diagnosis. Prostate biopsy, pivotal for clinical decisions, relies on transrectal biopsy as the norm, despite limitations like infection risk and incomplete sampling. An alternative, transperineal biopsy, grants broader access but demands more time and anesthesia. Escalating complications due to antibiotic resistance heighten apprehensions. Discrepancies in complications emerge from varied studies, while cancer detection rates stay consistent (45-49%). These conflicting outcomes raise vital safety issues. This study strives to bridge the information void by assessing complications within the local context, offering clarity for informed biopsy choices. With 150 words, the importance of evaluating biopsy methods in light of complications becomes evident, emphasizing the significance of this research in guiding clinical practice.

OBJECTIVE

This research aims to compare ultrasound guided transrectal prostate biopsy and freehand ultrasound guided transperineal biopsy at a Quezon City government hospital. Specific objectives include describing patient profiles for each technique, assessing infection rates, evaluating pain tolerance, comparing hematuria levels, measuring dysuria immediately post-biopsy and 1 day after, analyzing hospitalization rates, evaluating the techniques’ effectiveness in detecting prostate cancer, and reviewing histopathologic differences in prostatitis between the two methods.

METHODS

The study was conducted at the Veterans Memorial Medical Center Urology Section from January to October 2023. Using a prospective, descriptive, cross-sectional design, male patients undergoing ultrasound guided transrectal or transperineal prostate biopsies were included. Inclusion criteria include males aged 45 and above with PSA above 4.0 ng/dl and abnormal prostate findings. Exclusion criteria cover repeat biopsy cases and prior prostate cancer diagnosis. With an assumed 50% detection and complication rate, a minimum of 109 patients for each biopsy type was required for a 95% confidence level and 5% margin of error, totaling 218 participants.

RESULTS

The study compared transrectal and transperineal prostate biopsies in terms of patient characteristics, complications, diagnostic accuracy, and cancer detection rates. Patients undergoing transrectal biopsy had higher mean PSA levels (53.41 vs. 28.59, p=0.024) and received more fosfomycin prophylactic antibiotics (27% vs. 18%, p=0.044) compared to transperineal biopsy patients. Complication rates varied significantly between the two techniques, with chronic prostatitis seen in 5% of transperineal cases (p < 0.01). Transrectal biopsy patients experienced more pain, gross hematuria, urinary retention, fever, and hospitalization (p < 0.01). Diagnostic performance, assessed through the ROC curve’s area under the curve, showed comparable sensitivity and specificity for transrectal (AUC=0.559) and transperineal (AUC=0.441) biopsies (p=0.108). Cancer detection rates did not significantly differ between transrectal (34.4%) and transperineal (45.9%) biopsies (p=0.114). These results provide insights into the differences and similarities between the two biopsy techniques, impacting patient demographics, complications, and diagnostic outcomes.

CONCLUSION

This comparative investigation of transrectal and transperineal prostate biopsies in a tertiary hospital setting yields impactful insights. Participant ages were similar, but transrectal patients had higher PSA levels. Complication rates varied, with more chronic prostatitis in the transperineal group. Transperineal biopsies reduced pain, while transrectal group faced more complications. Cancer detection rates remained comparable. Transperineal biopsies demonstrated advantages in alleviating discomfort and potentially reducing complications. Tailoring biopsy approach based on patient profiles is crucial for diagnostic efficacy and patient well-being. These findings guide informed decision-making, prioritizing safety and experience in prostate biopsy practices.

Human ; Complications

INTRODUCTION: Insertion of foley catheter, a very common hospital procedure, is unwelcome to the patients, because of the catheter associated pain. Catheter pain is subdivided into pain experienced as the catheter is inserted (passed), while in situ, and on removal (reference I). Different techniques have been utilized to decrease pain on insertion ranging from local anaesthetic, anti septic gel and or generous lubricating jelly. Different studies have been made addressing the catheter. This maybe the first study which aims to decrease the pain with Foley catheter removal.

METHODS: All male patients who were catheterized at Veterans Memorial Medical Center from June to September 2008 were enrolled in the study. Patients with no history of prior catheterization were randomized into a control group and experimental. The control group were patients who would undergo the conventional foley catheter removal which is pulling out the catheter. The experimental groups were patients who would utilize the "Catheter Removal by Induced Microturition" technique of foley catheter removal. This was done by filling the bladder with saline/water through the patient's foley catether. When patient had the urge to void, filling was discontinued and one and void spontaneously.

RESULTS: A total of 181 male patients who underwent Urologic procedures were included in this study. Out of the 139 patients who had no previous history of catheterization, 67 patients were assigned into the control group and 72 patients into the experimental group. The experimental group had significantly lesser pain compared to the control group. The VAS of the control group was significantly higher than the intervention with mean of 3.36 and 0.31, respectively with p-values of 0.00. The other statistical tests used in this study were Wilcoxon- Matched- Pairs Signed Ranked test, and Mann-Whitney U-test.

CONCLUSION: Comparing the "control" and "experimental" group for patients with no history of catheterization show that the "Catheter Removal by Induced Micrturition" offers a significantly less painful experience compared to the group undergoing conventional pulling of the foley catheter. It is recommended that "Catheter Removal by Induced Microturition" technique be offered and applied to our patients in the aim of reducing their pain during catheter removal.

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