A consensus on men's health status and policy in Asia: a Delphi survey.

OBJECTIVE: There is currently no documentation on the availability and implementation of policies related to men's health in Asia. This Delphi study aimed to achieve an Asian consensus on men's health policy based on the opinions and recommendations from men's health key opinion leaders. STUDY DESIGN: A two-phase Delphi online survey was used to gather information from men's health stakeholders across Asian countries. METHODS: All stakeholders were invited to participate in the survey through men's health conferences, personal contacts, recommendations from international men's health organizations and snowballing method. Stakeholders were asked about their concerns on 17 men's health key issues as well as their opinion on the availability and recommendations on men's health policies and programmes in their countries. RESULTS: There were a total of 128 stakeholders (policy makers, clinicians, researchers and consumers), from 28 Asian countries, who responded in the survey. Up to 85% of stakeholders were concerned about various men's health issues in Asia and in their respective country, particularly in smoking, ischaemic heart disease and high blood pressure. There is a lack of men's health policies and programmes in Asia (availability = 11.6-43.5%) and up to 92.9% of stakeholders recommended that these should be developed. CONCLUSIONS: These findings call for policy change and development, and more importantly a concerted effort to elevate men's health status in Asia.

Testicular mass: do not forget filariasis.

Parasite infestation of the testicular tunica and spermatic cord by filariae are rarely reported and may present with few clinical signs, depending upon the stage. Occasionally, it may mimic a testicular tumor. We present a case of a 29-year-old man who presented with left testicular swelling and discomfort for 4 months. Clinical examination and imaging suggested an intrascrotal cystic lesion with a normal left testis. However, the intraoperative findings revealed a tumor-like mass; hence, a left orchidectomy was performed. However, histopathology reported a diagnosis of a cystic testicular tunica and spermatic cord with parasite infection. Here, we review the literature of scrotal and testicular parasite disease and discuss the course of the appropriate management involved.

Clinical Characteristics and Treatment Outcome of Gastrointestinal Non-Hodgkin's Lymphoma.

Primary gastrointestinal (GIT) lymphoma constitutes only 5 - 10% of all gastrointestinal tumours. The optimal therapy for these lymphomas is poorly defined and still controversial. We present our experience in the treatment and outcome of primary GIT lymphomas in UKM Medical Center, Malaysia. A retrospective review of all patients with primary GIT lymphoma from the year 2002 until 2007 was done. Our series has shown that primary GIT lymphoma is a rare disease as it comprises only 6.5% of all lymphomas treated in this institution. We had a female predominance of this disease with a large majority at an advanced stage of the disease. There was equal distribution involving stomach, small and large intestines. The incidence of primary GIT lymphomas was 6.5% with a female predominance. The majority had advanced diseases (stage III and IV) with equal distribution involving the stomach, small and large intestines. The most common histological variant was diffuse large B cell lymphoma (66%). Most (83%) patients with intestinal lymphoma had surgical resection and adjuvant chemotherapy. All patients with gastric lymphomas had chemotherapy alone. The mortality rate was 22% predominantly in younger patients with aggressive histology subtypes and advanced disease.

Proptosis: a rare presentation of metastatic renal cell carcinoma.

We present a case of a middle-aged man who was incidentally found to have right renal solid mass while investigating for his left eye proptosis. Computerised tomography (CT) scan confirmed the diagnosis of renal cell carcinoma and the tumour was successfully excised via open surgery. The histopathology examination revealed the 10x7x8 cm mass to be a clear cell type renal cell carcinoma. The rare presentation of this metastatic renal cell carcinoma, its diagnosis and management will be discussed.

Hand-assisted laparoscopic nephrectomy and nephroureterectomy: our experience in Hospital Universiti Kebangsaan Malaysia.

Hand-assisted laparoscopic nephrectomy (HAL-N) and nephroureterectomy (HAL-NU) were introduced to bridge the gap between open and laparoscopic surgery. This newer technique has the benefits of both laparoscopic and open surgical approaches but has a shorter learning curve and decreased operative time compared to laparoscopic surgery. A review of our 2-year experience showed that for the seventeen cases of HAL-N that was performed, the mean operative time was 187.8 minutes while the mean length of hospital stay was 4.1 days. For the two HAL-NU cases, the mean operative time was 415 minutes while the mean length of hospital stay was 5.5 days. Only one complication occurred and it was an incisional hernia at the hand-port site. There was no recurrence for the carcinoma cases. Our experience shows that this technique is feasible and safe.

Metastatic penile cancer presenting as hypercalcemia and pathological fracture of the humerus: a rare event.

Distant haematogenous metastasis in penile cancer is rare. A patient who had total penectomy and bilateral inguinal lymphadenectomy for penile cancer but later presented with hypercalcemia of malignancy and pathological fracture of the humerus is reported.

Scrotal lump: do not forget tuberculosis!

Scrotal tuberculosis (TB) is rare. Lack of awareness may lead to a misdiagnosis and/or delayed diagnosis of scrotal TB. Clinicians should have a high suspicion index for scrotal TB when facing a patient with a chronic scrotal lump. Since scrotal TB can be medically cured, biopsy of the scrotal lump for pathology study and/or urine polymerase chain reaction (PCR) analysis for M. tuberculosis should be performed first for rapid diagnostic purposes, and therefore unnecessary surgery may thereby be circumvented.

Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia.

OBJECTIVE: To determine the clinical utility of urinary bladder and prostate characteristics measured by ultrasound scan in predicting acute urinary retention (AUR) for men with bladder outlet obstruction with an underlying benign prostate hyperplasia (BPH). MATERIALS AND METHODS: Consecutive men aged ≥50 years presenting with lower urinary tract symptoms (LUTS) or AUR were prospectively recruited in this cross-sectional study. International prostatic symptom score (IPSS) and serum prostate-specific antigen (PSA) were recorded. High-resolution ultrasound was used to measure bladder detrusor thickness (DT, mm), prostatic volume (PV, cm3), intravesical prostatic protrusion (IPP, mm), bladder wall thickness (BWT,mm), intravesical volume and bladder radius. The latter two parameters were used to estimate bladder weight (UEBW, g), assuming a spherical bladder. RESULTS: Among selected patients, thirty had AUR while 32 men presented with LUTS only. There were significant differences between those with and without AUR in their age (70.5 vs 66.0, p=0.017), IPSS (24.0 vs 18.5, p=0.009), serum PSA (6.18 vs 1.77, p=0.002), PV (56.7 vs 32.4, p=0.006), BWT (5.0 vs 4.4, p=0.034) and UEBW (39.1 vs 25.0, p=0.0003). Multivariate analysis revealed high IPSS and UEBW to be predictors for AUR. UEBW was the strongest predictor of AUR: area under ROC curve was 0.767, with sensitivity and specificity of 63.3% and 87.5%, respectively, at cut-off point of 35 g. The likelihood ratio for AUR was also best with UEBW≥35 g. CONCLUSIONS: Combined with IPSS, ultrasound determined bladder characteristic, particularly UEBW, is a useful tool in predicting AUR in men with BPH.

A study of knowledge and attitudes of registered nurses towards pain management in an urban hospital.

BACKGROUND AND AIMS: Nurses play a pivotal role in pain management. Unrelieved pain significantly interferes with patient's quality of life and is of great concern to nurses. The aim of this study was to determine the knowledge level and attitudes of nurses related to pain management. MATERIALS AND METHODS: This descriptive study was conducted in an urban hospital. A total of 84 registered nurses were recruited using a modified version of questionnaire of Knowledge and Attitudes Survey Regarding Pain. RESULTS: The findings showed that respondents possessed good knowledge (99.12±14.810) and attitude (66.00 ±10.415) towards pain management. Fifty five respondents (66%) responded as positive to cultural beliefs affecting their pain management and 65 respondents (77%) viewed that their personal experiences had influenced their practice in pain management. Another 45 respondents (54%) reported they have attended pain course. There was no significant difference in pain management between respondents' year of service, cultural belief and personal experiences (p=>0.05). In terms of knowledge towards to pain management, respondents' age groups of more than 40 years were noted to possess better knowledge (p=0.046), unmarried respondents (p=0.018), and attended pain course (p=0.001) were significant. Attitude towards to pain management was not significant (p≤0.05). CONCLUSION: Nurses' knowledge and attitudes scores were impressive but there is room for further improvement to pain management. Continuing education organized by the hospital had significant impact on the nurses. However, this education course has to be reinforced from time to time in order to improve patients' pain experiences.

An unusual cause of a penetrating injury to the anterior urethra: a thorny situation.

Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.

Perception of quality of life amongst end stage renal failure patients undergoing haemodialysis.

AIMS: The objective of the study was to examine the quality of life amongst the end stage renal disease (ESRD) haemodialysis patients in Malaysia. MATERIALS AND METHODS: A cross sectional descriptive study was conducted on 72 ESRD patients at a Dialysis Centre in Malaysia. The modified KDQOL-SF™ subscales, kidney disease-targeted scale and 36 item health survey scale questionnaires were used. RESULTS: The overall health rating was 66.73 ± 11.670 indicating good quality of life. There was no significant difference between quality of life for the different domains according to gender (p >0.05). However, there were significant differences between quality of life in the domain of burden of kidney disease. Physical functioning deteriorated significantly with age (p=0.012) while social functioning was lowest in the 50-65 years age group (p=0.037). Those who had no morbidities had significantly better scores on the effects of kidney (p=0.036), burden of kidney disease (p=0.011) and physical functioning (p=0.025). CONCLUSIONS: Patients undergoing haemodialysis have been found to have good quality of life despite having ESRD. It is therefore of paramount importance to constantly monitor the standard of care for these patients to enable them to live their life to the fullest.

Nurses compliance to hand hygiene practice and knowledge at Klang Valley hospital.

BACKGROUND AND AIMS: Hand hygiene is the most important measure in the prevention of healthcare-associated infections (HCAI). Adherence to hand hygiene protocols in hospital by nurses enables in prevention and control the HCAI. The main aim of the present study was to assess nurses' compliance to hand hygiene practice and knowledge in a hospital. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted in the intensive care units of a hospital in Kuala Lumpur. A total of 84 registered nurses from the intensive care were recruited for this study. A self-administered questionnaire was deployed to measure knowledge and compliance about hand hygiene. RESULTS: The findings showed the total mean and standard deviation of knowledge (60.65±4.213) and compliance (84.65±7.024) to be high among the respondents. There were no significant differences with the knowledge and compliance to hand hygiene with respondents' age groups with a p value >0.05. However, there were significant differences between respondents' years of service with the knowledge and compliance with p values <0.05. The results showed significant differences between respondents' with post basic course with compliance to hand hygiene with a p value <0.05 actual p value added (p = 0.001). There were no significant differences between the respondents' post basic course with knowledge to hand hygiene with p values >0.05 actual p value added (p=0.072). CONCLUSION: Nurses compliance to hand hygiene practice and knowledge was good. Nurses' years of service have great implications on compliance to hand hygiene practice. The study opines that constant reinforcement and motivation are required by the hospital infection control team to impart hand hygiene practice.

Ureteric stone in the presence of existing backache: lessons to learn.

Incidence of urolithiasis is on the rise due to climatic changes especially global warming.The pain due to presence of ureteric stone is a well known identity but many times it may be asymptomatic or even masked by concurrent presence of backache. In the present article, we describe the case of a 43-year-old male who came to the clinic for treatment of backache persisting for more than two years. The patient complained of backache two years back for which he was treated with analgesics and physiotherapy which relieved his pain. No X-ray was taken earlier because the attending clinician thought the backache to be musculo-skeletal in origin. Recently, one day a sudden episode of backache in the midst of night compelled him to seek medical treatment. However, this time a X-ray was performed and it showed the presence of calculi in the right upper pelvis of ureter which measured 1.9 cm vertically. An ultrasound confirmed the diagnosis. The patient was treated with two episodes of shock wave therapy which failed to crush the stone. A Double-J stent was inserted under general anaesthesia. The stone was crushed using a ureteroscope guided laser. The present case report describes how backache in professionals cannot be lightly attended. Even the characteristic groin to loin pain may be absent. All cases of backache should be properly investigated with an X-ray to rule out renal or ureteric calculi.

Evaluation of power Doppler ultrasonography for prostate biopsy in men with elevated serum prostate specific antigen levels.

OBJECTIVES: To evaluate power doppler ultrasonography (PDU)-directed prostate biopsy in patients with elevated serum prostate specific antigen (PSA) levels. MATERIALS AND METHODS: Men with serum total PSA levels of more than 4 ng/ml undergoing biopsy for the first time were included. Grey-scale transrectal ultrasound (TRUS) and PDU were performed. PDU signal on vascularity accumulation and perfusion characteristics were recorded and graded as normal or abnormal in the peripheral zone of the prostate. Abnormalities were defined on transverse image as radial or arc hypervascularities. A biopsy regime based on Vienna-normogram was performed in all patients. RESULTS: Overall, prostate adenocarcinoma detection rate was 21.4% and abnormal accumulation on PDU signal was identified in 96.7% of those patients (p = 0.01). PDU directed prostate biopsies were positive in 66.7% of the patients with prostate cancer. The sensitivity, specificity, positive predictive value and negative predictive value of PDU signal alone for prostate cancer detection was 96.7%, 24.5% and 96.4% respectively, and PDU guided biopsies were 66.7%, 24.5%, 19.4% and 73% respectively. CONCLUSIONS: The high sensitivity and negative predictive value of PDU makes it useful as an aid for TRUS biopsy in selected patient with previous negative biopsies at risk of harbouring prostate cancer.

Clinicopathological features and survival of testicular tumours in a Southeast Asian university hospital: a ten-year review.

INTRODUCTION: Testicular cancer mainly affects young men worldwide. There is lack of published data on patients with this malignant condition from the Southeast Asian region. The aim of this study was therefore to determine the clinicopathologic features of testicular cancer patients treated in a Southeast Asian university hospital and their overall survival rate. MATERIALS AND METHODS: This was a retrospective study of testicular cancer patients treated between January 2001 and February 2011. Their epidemiological data, clinical presentation, pathologic diagnosis, stage of disease and treatment were gathered and the overall survival rate of this cohort was analyzed. RESULTS: Thirty-one patients were included in this study. The majority of them were of Malay ethnicity. The average age at presentation was 33.7 years. The commonest testicular cancer was non-seminomatous germ cell tumour, followed by seminoma, lymphoma and rhabdomyosarcoma. More than half of all testicular germ cell tumour (GCT) patients had some form of metastasis at diagnosis. All the patients were treated with radical orchidectomy. Adjuvant chemotherapy was given to those with metastatic disease. Four seminoma patients received radiotherapy to the para-aortic lymph nodes. The 5-year survival rate for all testicular cancers in this cohort was 83.9%. The survival rate was 88.9% in 5 years when GCT were analyzed separately. CONCLUSION: GCT affects patients in their third and fourth decades of life while lymphoma patients are generally older. Most of the patients treated for GCT are of Malay ethnicity. The majority have late presentation for treatment. The survival rate of GCT patients treated here is comparable to other published series in other parts of the world.

Retrograde intrarenal surgery for renal stones smaller than 2 cm.

INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is accepted as the gold standard treatment for renal stones that are smaller than 2 cm. Recently, retrograde intrarenal surgery (RIRS) has been introduced as another form of treatment. We report our experience in dealing with renal stones smaller than 2 cm using RIRS as the primary treatment and following failed ESWL. METHODS: A retrospective analysis was conducted over a five-year period on patients with stone(s) measuring less than 2 cm each and who had undergone RIRS. The patients were divided into two groups: RIRS as the primary procedure and RIRS post-ESWL. RESULTS: A total of 46 patients underwent RIRS in our institute. The total stone clearance rate was 61 percent. The clearance rate was better for RIRS as the primary procedure when compared to RIRS as an adjunct procedure (70 percent versus 52 percent; p-value is 0.23). Patients with mid-pole stones achieved an 80 percent stone clearance rate as compared to 60 percent for those with lower pole stones. The clearance rate for upper pole stones was only 29 percent. When RIRS was the primary procedure for lower pole stones, the success rate was 75 percent, compared to 56 percent when it was used as an adjunct procedure post-ESWL. CONCLUSION: For renal stones measuring less than 2 cm, the stone clearance rate for RIRS was as good as that for EWSL as a primary procedure and achieved a good clearance rate following the failure of ESWL.