Prostatic Artery Embolisation for Refractory Haematuria in Advanced Prostate Cancer: A Case Report of PSA Normalisation Prostatic artery embolisation (PAE) is a well-established minimally invasive procedure for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. In patients with advanced prostate cancer, its primary role has been palliative, particularly for controlling refractory haematuria. However, emerging evidence suggests that PAE may offer additional cytoreductive benefits. We presented the case of an 85-year-old male with advanced prostate cancer and multiple comorbidities, including severe aortic stenosis and stage 4 chronic kidney disease, who developed refractory gross haematuria unresponsive to conservative management. Due to high surgical risk, bilateral PAE was performed via a single right femoral artery access. The procedure resulted in complete resolution of haematuria, allowing early catheter removal. Remarkably, his prostate-specific antigen (PSA) declined from 5.28 ng/mL to 0.45 ng/mL over seven months, in the absence of systemic therapy. The patient remained haematuria-free with improved voiding symptoms. This case highlights the effectiveness of PAE for haemostatic control in advanced prostate cancer and suggests potential cytoreductive effects, evidenced by sustained PSA normalisation. PAE may serve a dual role in symptom control and disease modulation in patients unsuitable for surgery or systemic therapy. Further studies are warranted to explore its oncologic impact.

Rare Occurrence of Paratesticular Rhabdomyosarcoma in Adulthood: A Case Report Paratesticular rhabdomyosarcoma is an extremely rare malignant tumour that primarily affects pediatric patients but is uncommon in adults. Prompt diagnosis and treatment are essential to prevent metastasis and improve prognosis. A 28-year-old male was presented with a painless right scrotal swelling. Physical examination revealed a palpable mass in the right scrotal region, raising suspicion of a malignant tumour. Ultrasonography showed a hypoechoic mass originating from the right epididymis. The patient underwent a high inguinal orchidectomy, and histopathological examination confirmed the diagnosis of paratesticular rhabdomyosarcoma. Staging computed tomography revealed no evidence of metastasis. The patient received chemotherapy based on risk stratification. Paratesticular rhabdomyosarcoma carries a poor prognosis in advanced stages, highlighting the importance of early diagnosis. Surgery remains the mainstay of treatment and the role of adjuvant therapy in adults is not well established. Understanding the clinical manifestations, diagnosis and treatment of this rare malignancy can aid in improved management and outcomes

ABSTRACT Erectile dysfunction (ED) is one of the common sexual disorders affecting many men worldwide. Owing to shared common risk factors, periodontitis is related to ED. However, the prevalence of periodontitis among Malaysian patients with ED is currently unknown. This study aimed to investigate the prevalence of periodontitis in patients with ED in Malaysia and the factors associated with this relationship. Forty-one subjects aged 27–59 years old were recruited to participate in this study. The International Index of Erectile Function (IIEF-5) was used in assessing the presence of ED. Their periodontal health was assessed through comprehensive periodontal examination including plaque index, bleeding on probing and clinical attachment level. The subjects were categorised according to the severity of their periodontal health and ED. A questionnaire on general health and oral habits was administered. The prevalence of periodontitis (95.5%) among subjects with ED was significantly higher than those without ED (52.6%). Subjects with ED had the worst periodontal health, as indicated by the mean clinical attachment loss and percentage of sites with bleeding on probing. No differences in oral hygiene habits were found between subjects with and without ED. The prevalence of periodontal disease among Malaysian patients with ED was high. Periodontitis was positively associated with the severity of ED, supporting a dose-dependent association between the two diseases. Oral hygiene habits were not significantly related to any periodontitis parameters nor were significantly different between subjects with and without ED.
Erectile Dysfunction ; Periodontitis

BACKGROUND: The urinary tract can be affected by both congenital abnormalities as well as acquired disorders, such ascancer, trauma, infection, inflammation, and iatrogenic injuries, all of which may lead to organ damage requiring eventualreconstruction. As a gold standard, gastrointestinal segment is used for urinary bladder reconstruction. However, one majorproblem is that while bladder tissue prevents reabsorption of specific solutes, gastrointestinal tissue actually absorbs them.Therefore, tissue engineering approach had been attempted to provide an alternative tissue graft for urinary bladderreconstruction. METHODS: Human adipose-derived stem cells isolated from fat tissues were differentiated into smooth muscle cells andthen seeded onto a triple-layered PLGA sheet to form a bladder construct. Adult athymic rats underwent subtotal urinarybladder resection and were divided into three treatment groups (n = 3): Group 1 (‘‘sham’’) underwent anastomosis of theremaining basal region, Group 2 underwent reconstruction with the cell-free scaffold, and Group 3 underwent reconstructionwith the tissue-engineered bladder construct. Animals were monitored on a daily basis and euthanisation wasperformed whenever a decline in animal health was detected. RESULTS: All animals in Groups 1, 2 and 3 survived for at least 7 days and were followed up to a maximum of 12 weekspost-operation. It was found that by Day 14, substantial ingrowth of smooth muscle and urothelial cells had occurred inGroup 2 and 3. In the long-term follow up of group 3 (tissue-engineered bladder construct group), it was found that theurinary bladder wall was completely regenerated and bladder function was fully restored. Urodynamic and radiologicalevaluations of the reconstructed bladder showed a return to normal bladder volume and function.Histological analysisrevealed the presence of three muscular layers and a urothelium similar to that of a normal bladder. Immunohistochemicalstaining using human-specific myocyte markers (myosin heavy chain and smoothelin) confirmed the incorporation of theseeded cells in the newly regenerated muscular layers. CONCLUSION Implantation of PLGA construct seeded with smooth muscle cells derived from human adipose stemcells can lead to regeneration of the muscular layers and urothelial ingrowth, leading to formation of a completelyfunctional urinary bladder.

BACKGROUND: The urinary tract can be affected by both congenital abnormalities as well as acquired disorders, such ascancer, trauma, infection, inflammation, and iatrogenic injuries, all of which may lead to organ damage requiring eventualreconstruction. As a gold standard, gastrointestinal segment is used for urinary bladder reconstruction. However, one majorproblem is that while bladder tissue prevents reabsorption of specific solutes, gastrointestinal tissue actually absorbs them.Therefore, tissue engineering approach had been attempted to provide an alternative tissue graft for urinary bladderreconstruction. METHODS: Human adipose-derived stem cells isolated from fat tissues were differentiated into smooth muscle cells andthen seeded onto a triple-layered PLGA sheet to form a bladder construct. Adult athymic rats underwent subtotal urinarybladder resection and were divided into three treatment groups (n = 3): Group 1 (‘‘sham’’) underwent anastomosis of theremaining basal region, Group 2 underwent reconstruction with the cell-free scaffold, and Group 3 underwent reconstructionwith the tissue-engineered bladder construct. Animals were monitored on a daily basis and euthanisation wasperformed whenever a decline in animal health was detected. RESULTS: All animals in Groups 1, 2 and 3 survived for at least 7 days and were followed up to a maximum of 12 weekspost-operation. It was found that by Day 14, substantial ingrowth of smooth muscle and urothelial cells had occurred inGroup 2 and 3. In the long-term follow up of group 3 (tissue-engineered bladder construct group), it was found that theurinary bladder wall was completely regenerated and bladder function was fully restored. Urodynamic and radiologicalevaluations of the reconstructed bladder showed a return to normal bladder volume and function.Histological analysisrevealed the presence of three muscular layers and a urothelium similar to that of a normal bladder. Immunohistochemicalstaining using human-specific myocyte markers (myosin heavy chain and smoothelin) confirmed the incorporation of theseeded cells in the newly regenerated muscular layers. CONCLUSION Implantation of PLGA construct seeded with smooth muscle cells derived from human adipose stemcells can lead to regeneration of the muscular layers and urothelial ingrowth, leading to formation of a completelyfunctional urinary bladder.

BACKGROUND: Urinary tract is subjected to a variety of disorders such as urethral stricture, which often develops as a result of scarring process. Urethral stricture can be treated by urethral dilation and urethrotomy; but in cases of long urethral strictures, substitution urethroplasty with genital skin and buccal mucosa grafts is the only option. However a number of complications such as infection as a result of hair growth in neo-urethra, and stone formation restrict the application of those grafts. Therefore, tissue engineering techniques recently emerged as an alternative approach, aiming to overcome those restrictions. The aim of this review is to provide a comprehensive coverage on the strategies employed and the translational status of urethral tissue engineering over the past years and to propose a combinatory strategy for the future of urethral tissue engineering. METHODS: Data collection was based on the key articles published in English language in years between 2006 and 2018 using the searching terms of urethral stricture and tissue engineering on PubMed database. RESULTS: Differentiation of mesenchymal stem cells into urothelial and smooth muscle cells to be used for urologic application does not offer any advantage over autologous urothelial and smooth muscle cells. Among studied scaffolds, synthetic scaffolds with proper porosity and mechanical strength is the best option to be used for urethral tissue engineering. CONCLUSION: Hypoxia-preconditioned mesenchymal stem cells in combination with autologous cells seeded on a prevascularized synthetic and biodegradable scaffold can be said to be the best combinatory strategy in engineering of human urethra.
Cicatrix ; Data Collection ; Hair ; Humans ; Mesenchymal Stromal Cells ; Mouth Mucosa ; Myocytes, Smooth Muscle ; Porosity ; Skin ; Tissue Engineering ; Transplants ; Urethra ; Urethral Stricture ; Urinary Tract

The purpose of this study was to determine the prevalence and factors associated with of Premature Ejaculation &Erectile Dysfunctionamong Malaysian men.A cross-sectional study was conducted in urban and rural areas using standardized and validated self-administeredquestionnaires.A total of 319 samples were recruited for PE screening. The overall prevalence of PE was 31.7% with 20.7% and 40.8% for urban and rural arearespectively. Depression, anxiety and frequent masturbation were significantly associated with PE. While For ED, infrequent sexual intercourse was the sole factor significantly associated with ED.PE and ED were highly prevalent in both urban and rural areas; with several significant preventable associated factors.
Premature Ejaculation ; Erectile Dysfunction ; Sexual Dysfunction ; Malaysia

Nutrition has been widely recognized to have certain levels of influence on the risk of kidney stone formation. Thus, this case-control study was conducted to determine the association of dietary intake and lifestyles factors with kidney stone disease. Sociodemographic data, dietary intake, supplements intake, smoking and alcohol habit, medical history, physical activity and anthropometric data were obtained using interviewer-administered pre-tested questionnaires among 81 patients who had been diagnosed with kidney stone disease and 81 patients without kidney stone disease at Universiti Kebangsaan Malaysia Medical Centre. The results indicated that body mass index and hip circumference were higher among cases as compared to controls in both men and women (p < 0.05). Energy, macronutrients and micronutrients intake were higher for case subjects compared to control subjects for all significant parameters (p < 0.05). Results showed positive association of kidney stone with consumption of nuts (≥1 time/week) for men and women while consumption of eggs (1-3 times/month) and beans (1-6 times/week) showed positive association for women. Analysis of multivariate found the risk factor among women was diabetes mellitus [Adjusted OR = 27.6 (95% CI = 1.43-53.3)] (p < 0.05). Whilst, plain water intake of at least 6 glasses [Adjusted OR = 0.001 (95% CI = 0.000-0.08)] (p < 0.05) and 8 glasses per day [Adjusted OR = 0.001 (95% CI = 0.000-0.02)] (p < 0.05) reduced the risk among women. The risk factors for men were smoking habits [Adjusted OR = 16.2 (95% CI = 1.29-203)] (p < 0.05), consumption of carbonated drink 1-3 times per month [Adjusted OR = 6.25 (95% CI = 1.04-40.7)] (p < 0.05) and 1-6 times per week [Adjusted OR = 12.5 (95% CI = 1.41-111)] (p < 0.05). Unhealthy dietary and lifestyles factors increased the risk of kidney stone disease and various risk factors were found for different sexes.
Kidney Calculi

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

Ketamine can be abused as a recreational drug, and there has been a recent surge in its usage. The effects of ketamine on the urinary system were unknown until the recent publication of a few case reports. Many doctors are still unaware of this new clinical entity, termed ketamineassociated ulcerative cystitis. We report a case that we encountered and discuss the diagnosis and disease management in addition to a review of the literature.