The Surgical Management of Large Bladder Calculi and Irreducible Uterine Prolapse: A Case Report and Review of Literature.

Bladder calculi are rare in women. We report a case of bladder calculi complicating irreducible uterovaginal prolapse. It provides diagnostic and operative challenges to the management team. A 77-year-old woman presented with irreducible complete uterovaginal prolapse. Bladder stones were appreciated on examination and confirmed with imaging. The patient was managed surgically with transabdominal hysterectomy with bilateral uterosacral colpopexy followed by cystolithotomy. The patient's postoperative course was uncomplicated, and she had an uneventful recovery at her 3-month postoperative visit without a recurrence of prolapse and gained good continence. The presence of bladder calculi should be considered in the setting of irreducible pelvic organ prolapse. The abdominal approach of cystolithotomy with a concomitant hysterectomy and vaginal apical suspension is safe and effective.

Local treatment with a polycarbophil-based cream in postmenopausal women with genitourinary syndrome of menopause.

INTRODUCTION AND HYPOTHESIS: Genitourinary syndrome of menopause (GSM) is a common problem associated with lower urinary tract and gynecological symptoms due to the decrease in estrogen production in postmenopausal women. Topical estrogen therapy is shown to improve these symptoms; nonetheless, there are limited data on the efficacy of nonhormonal moisturizers in these patients. METHODS: A prospective cohort study was conducted to compare the symptoms of GSM before and after treatment with a polycarbophil-based cream in 42 women. The quality of life (QoL) and sexual scores were obtained from the Thai version of the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms (ICIQ-LUTS) along with uroflow measurements before and 4 and 12 weeks after treatment. RESULTS: Significant improvements in ICIQ-LUTSqol scores were observed after 4 weeks (9.38 ± 7.47 vs 6.76 ± 5.77; p = 0.017) and 12 weeks (10.03 ± 7.49 vs 5.97 ± 4.02; p = 0.002) when compared with the baseline values before treatment. The ICIQ-LUTS sexual scores were also improved after treatment at 4 weeks (2.29 ± 2.26 vs 0.88 ± 1.34; p < 0.001) and 12 weeks (2.13 ± 2.22 vs 0.42 ± 0.81; p < 0.001) compared with the baseline scores. No differences in ICIQ-LUTSqol and sexual scores were observed between the 4- and 12-week treatment groups. CONCLUSION: The polycarbophil-based cream improved the overall LUTS and sexual symptoms in the patients with GSM, thus indicating that the nonhormonal polycarbophil-based cream may prove effective for the treatment for women with this condition.

Is Combined Ultrasound with Radiography Sufficient for the Diagnosis of Obstructive Ureteric Stone in Patients with Acute Flank Pain?

CONTEXT: Ultrasound (US) is excellent for detection of hydronephrosis but has poor sensitivity for stone detection. In contrast, radiography of the kidney-ureter-bladder has better sensitivity for detection of stone but limited sensitivity for hydronephrosis detection. A combination of these two modalities may improve both sensitivity and specificity for the diagnosis of obstructive ureteric stone. AIMS: This study aims to investigate the diagnostic accuracy of combined US with radiography for the diagnosis of obstructive ureteric stone in adult patients. SETTINGS AND DESIGN: Retrospective study with retrospective data collection performed in a 1500-bed university hospital. MATERIALS AND METHODS: A total of 90 patients were included. The electronic medical record, radiological reports, laboratory results, and patient management were extracted and analyzed. STATISTICAL ANALYSIS USED: The diagnostic performance of US, radiography, and combined US with radiography were calculated and compared. The computed tomography was used as diagnostic reference. RESULTS: US alone had a sensitivity of 73.5%, specificity of 92.7%, and negative predictive value (NPV) of 74.5% for hydronephrosis. When US showed both ureteric stone and hydronephrosis, sensitivity dropped to 14.3% but specificity increased to 100%. Radiography alone had a sensitivity of 34.7%, specificity of 100%, and NPV of 56.2% for the detection of ureteric stone. Combining radiography with US raised the sensitivity for diagnosis of obstructive ureteric stone to 88% with a specificity of 93% and accuracy of 90%. CONCLUSIONS: Combined US with radiography was accurate for the diagnosis of obstructive ureteric stone in patients presenting with acute flank pain.

Incidence of Fluoroquinolone Resistant Aerobic Organisms and Efficacy of Rectal Cleaning in Men Undergoing Transrectal Ultrasound Guided Prostate Biopsy.

Objective: To evaluate the incidence of fluoroquinolone resistant organisms in rectum and efficacy of rectal cleansing in men undergoing transrectal ultrasound guided prostate biopsy (TRUS-Bx) in Ramathibodi Hospital. Material and Method: Between December 2012 and March 2013, 105 male patients who had prostate specific antigen (PSA) more than 4 ng/ml or abnormal digital rectal examination (DRE) underwent TRUS-Bx were enrolled. Two specimens of rectal swab for bacterial culture were taken from each patient. The first rectal swab was obtained at the beginning of the procedure (BC), another after cleaning the rectum with betadine solution (AC). All gram-negative enteric bacteria were isolated. The results of both specimens were analyzed by Chi-square test and McNemar test. Results: One hundred five men that underwent TRUS-Bx were included in the present study. Of the 105 patients, 15 men were found to have no bacterial growth while 90 men showed bacterial growth at the BC procedure. After the AC procedure, 53 men (59%) remained having positive culture for bacterial strains (p<0.001), and 37 (41%) showed no bacterial growth. There was no change in the bacterial strains in 36 men while another four men demonstrated an increasing number of bacterial strains at the AC stage. Of 90 patients, 81 (90%) men carried ciprofloxacin resistant organisms including Escherichia coli (E. coli) (55.56%), extended-spectrum ß-lactamase (ESBL)-producing E. coli (35.80%), Klebsiella pneumoniae (6.17%), and Enterobacter cloacae (2.47%). Conclusion: Incidence of fluoroquinolone resistant organisms in rectum of men undergoing TRUS-Bx at Ramathibodi Hospital was approximately 90%. E. coli was the most common organism. The results indicated that rectal cleaning significantly decreases the incidence of overall bacterial colonization in rectum before TRUS-Bx.

R.E.N.A.L. nephrometry score in clinical stage T1 renal mass: Ramathibodi hospital experience.

OBJECTIVE: The main treatment strategies for clinical stage T1 renal mass are radical nephrectomy (RN) and partial nephrectomy (PN). Treatment decision depends largely on tumor complexity as assessed by the R.E.N.A.L. nephrometry scoring system. The authors evaluated our experience with R.E.N.A.L. nephrometry score in all patients who underwent surgery. MATERIAL AND METHOD: The authors evaluated 61 patients who presented with clinical stage T1 renal mass and underwent radical or partial nephrectomy between 2007 and 2013 at Ramathibodi Hospital. Tumor complexity was quantified by R.E.N.A.L. nephromety score in all patients using preoperative imaging. Statistical analysis was done to study associations. RESULTS: Sixty-one patients were included in this study, which 34 (55.70%) were male and 27 (44.30%) were female. The most common pathologic report was clear cell renal cell carcinoma followed by angiomyolipoma and papillary renal cell carcinoma. Forty-one patients underwent radical nephrectomy, of whom three, 25, and 10 patients had low, moderate, and high tumor complexity respectively. Twenty patients underwent partial nephrectomy, of whom 10 patients had low tumor complexity and 10 patients had moderate tumor complexity. No patient had high tumor complexity. In the present study, the function coefficient showed that radius had the most influence on surgical decision-making,followed by nearness to collecting system, exophytic/endophytic, and location. We also developed the Ramathibodi equation to help selecting the proper operation. CONCLUSION: The R.E.N.A.L. nephrometry score is a feasible and standardized classification system for evaluating renal masses. It could be used to stratify tumor complexity and may help for surgical decision-making.

Factors affecting results of hypospadias repair: single technique and surgeon.

OBJECTIVE: To review our experience of using the tubularized incised plate (TIP) urethroplasty to treat all type of hypospadias and identify factors that affect the results and complications. MATERIAL AND METHOD: A retrospective medical records review of 90 patients with hypospadias treated with TIP urethroplasty between November 2007 and March 2012 was performed. The operation was done by TIP technique in eighty patients. The entire length of the urethral plate was incised along the midline and the neourethra was tubularized over a 6 or 8 Fr feeding tube with Maxon or Vicryl 6-0 suture. The urethral stent was removed on the third to seventh post-operative day. All operations were done by the same surgeon. Postoperative follow-up was at least one year in all patients. Presence of complications requiring reoperation and overall general appearance were recorded. RESULTS: TIP was performed in 80 boys, age ranged from 11 months to 15 years (mean age 2.5 years). Distal hypospadias was found in 15, midshaft in 18, proximal in 16, and penoscrotal in 31 patients. Overall success rate was 76.25%. Re-operation was required in 19 patients (23.75%): for urethrocutaneous fistula in 12 (15%), complete disruption of the repair in three (3.75%) and meatal stenosis in four (5%). The meatal stenosis was managed by simple dilatation in all patients. All fistulas, except for one, were successfully repaired in a single operation. Complications increased in penoscrotal hypospadias and repaired at early period. Age at surgery did not increase complications rate. CONCLUSION: TIP repair is a reliable method for treating all types of hypospadias. Complications rate may depend on type of hypospadias and increase in proximal and penoscrotal location. Our data indicate age at surgery does not increase urological complications. A better outcome is achieved with good experience.

Reliability of a Thai version of the International Prostate Symptom Score (IPSS) for the Thai population.

OBJECTIVE: To develop and test the reliability of a Thai version of the International Prostate Symptom Score (IPSS-Th). MATERIAL AND METHOD: A Thai version of the International Prostate Symptom Score (IPSS-Th) was developed after conducting many steps. The original English version of the International Prostate Symptom Score (IPSS) was translated into Thai by three urologists working independently. After having compared the original English version with various translations, the final Thai version was obtained. Fifty Thai males possessing a good understanding of both English and Thai were asked to complete the Thai version of the IPSS. Two weeks later, they were asked to complete the English version of the IPSS. Internal consistency was assessed using Cronbach's alpha. Next, 118 Thai males were tested using the Thai version of the IPSS and retested after two weeks. As such, the reliability of the Thai version of the IPSS was evaluated using the test-retest method. RESULTS: For the Thai IPSS version, Cronbach's alpha was 0.77 and the English version of the IPSS was 0.88. The test-retest reliability was 0.96. CONCLUSION: The Thai version of the IPSS was found to be reliable and should be a useful tool for patient assessment, follow-up, and research in the population of Thai-speaking patients.

The best calyceal tract approach for treating renal stones with percutaneous nephrolithotomy.

OBJECTIVE: To compare the perioperative outcomes of percutaneous nephrolithotomy (PCNL) performed via the upper middle, and lower calyces. MATERIAL AND METHOD: The authors retrospectively reviewed 92 renal units in 92 patients who required PCNL at our institution between 2006 and 2010. Patients with partial and full staghorn stones with total stone size > or = 2 cm were included in the present study. Patients were excluded if they had multiple small stones or a single stone < 2 cm. The present study analyzed 92 renal units in 92 patients. The authors divided the patients into three groups (groups 1, 2, and 3) based on the surgical approach, which was the upper middle, and lower calyceal approaches. PCNL was performed using a standard ultrasonic lithotriptor with a rigid nephroscope, and holmium: YAG laser lithotripsy was carried out with a flexible nephroscope, with simultaneous nitinol tipless basket extraction of fragments. Procedures were repeated until the patients were rendered stone-free (confirmed visually or by nephrostogram). Estimated blood loss, length of hospital stay, operative time, and the number of procedures (to achieve stone-free status) were analyzed and compared among the groups, and complications were reported. RESULTS: The present study showed that the length of hospital stay, estimated blood loss, number of procedures, and operative time were not significantly different between the three groups. In Group 1, four patients had complications and included two patients with mid-ureteral stone, and one patient each with renal pelvic perforation and urinary tract infection with sepsis. One patient from Group 2 contracted a urinary tract infection. In Group 3, five patients exhibited complications and included one with mid-ureteral stone, two with renal hemorrhage, and two with urinary tract infection. CONCLUSION: The estimated blood loss, duration of hospital stay, operative time, number of procedures (to achieve stone-free status), and complications did not statistically differ between the three groups. Moreover very few complications occurred in the different surgical approaches. Therefore, PCNL via all the three approaches were deemed safe and effective.

A clinicopathologic study of tuberculous epididymo-orchitis in Thailand.

Tuberculous epididymo-orchitis is an uncommon disease caused by Mycobacterium tuberculosis of the testis and epididymis. We reviewed 25 cases of tuberculous epididymo-orchitis, diagnosed at the Faculty of Medicine Ramathibodi Hospital, Mahidol University between July 2000 and June 2010. The mean age at diagnosis was 54.5 years (range: 30 to 91 years). Cultures from testicular and epididymal tissues were positive for Mycobacterium tuberculosis in 6 cases. The clinical presentations of tuberculous epididymo-orchitis included scrotal mass (80%), scrotal pain (44%), micturition syndrome (8%), urethral discharge (4%), and scrotal fistula (4%). One third of the patients had pulmonary tuberculosis. Four patients (16%) had underlying human immunodeficiency virus infection. Tuberculous epididymo-orchitis should be considered in the patients who present with a scrotal mass. The preoperative differentiation of tuberculous epididymoorchitis from non-tuberculous epididymo-orchitis and testicular tumor is difficult. In patients who have epididymal and testicular lesions, surgical excision provides the diagnosis. Exact histopathologic categorization is important to select appropriate medical therapy.

Implementation of Supine Percutaneous Nephroscopic Surgery to Remove an Upward Migration of Ureteral Catheter in Infancy: A Case Report.

BACKGROUND: Double-J stents are favorably utilized after pyeloplasty. In rare situations, the stent may migrate upward. Here, we demonstrate the implementation and result of a supine percutaneous nephroscopic surgery (PNS) to retrieve a proximately migrated ureteral catheter in a pediatric patient. PATIENT AND METHODS: A 1-year-old boy was suffering from an upward migration of a ureteric catheter into the right ureter after an open Anderson-Hynes pyeloplasty. The child was placed in the Galdakao-modified supine Valdivia (GMSV) position and a PNS procedure was performed. The calyceal access was carefully punctured by ultrasonographic guidance. The nephrostomy tract was dilated with a metal dilator using a one-step technique. An exploratory nephroscopy of the renal pelvis was conducted with a 12Fr miniature nephroscope and the migrated ureteral catheter was removed. A hybrid guidewire was retrogradely inserted into the ureteric orifice using a rigid ureteroscope. An antegrade double J stent was inserted in the proper position and a percutaneous nephrostomy was performed. RESULTS AND CONCLUSION: This is the first report of a successfully removed upwardly migrated ureteral catheter with concurrent insertion of an antegrade double J stent by supine PNS in the GMSV position in an infant. The patient recovered well after surgery with no adverse event, demonstrating that this operation can be carried out safely on pediatric patients.

Comparative Outcomes and Predictive Assessment of Trifecta in Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy Cases with Renal Cell Carcinoma: A 10-Year Experience at Ramathibodi Hospital.

PURPOSE: To compare perioperative and trifecta outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted laparoscopic partial nephrectomy (RPN) in patients with small renal mass at Ramathibodi Hospital, and to determine predictive factors in connection with trifecta. METHODS: We retrospectively reviewed 141 patients who underwent partial nephrectomy by eight experienced surgeons from January 2009 to December 2018. Baseline preoperative characteristics, postoperative and trifecta outcomes of the three treatment modalities were compared and analyzed. Univariate analysis was performed to determine predictive factors for trifecta achievement. RESULTS: A total of 70 patients had complete data available. Eighteen OPN, 11 LPN and 41 RPN cases were identified and reviewed. All preoperative and perioperative parameters were similar, except for operative time, which was significantly shorter in the OPN group compared with those undergoing LPN and RPN (135 vs 189 and 225 min, respectively; p-value = 0.001). Of these 70 patients, 59 were deemed eligible for and included in trifecta analysis, which revealed similar trifecta outcomes (64.29%, 45.45%, and 64.71% in the OPN, LPN, and RPN groups, respectively; p-value = 0.388). Univariate analysis showed that length of hospital stay was a negative associated factor for trifecta achievement (p-value = 0.007, 95% CI = 0.619 (0.44-0.88)). CONCLUSION: Although OPN displayed the shortest operative time, the trifecta achievement rate was not significantly different among the three groups. The sole parameter, which was negatively associated with trifecta outcome achievement, was the length of hospital stay.

Case report and review: prenatal diagnosis of congenital megalourethra.

Megalourethra is a rare congenital anomaly characterized by dilatation of the penile urethra which causes functional obstruction of the lower urinary system. We present a case of congenital megalourethra diagnosed prenatally. Transabdominal sonography revealed a male fetus with bilateral hydroureter, hydronephrosis, dilated bladder and normal amniotic fluid. The fetal penis was enlarged and the penile urethra was dilated with ballooning at the distal end. The urethral meatus was identified. The fetus was delivered at term with a favorable outcome.

Traumatic Blunt Force Renal Injury in a Diseased Horseshoe Kidney with Successful Embolization to Treat Active Bleeding: A Case Report and Literature Review.

BACKGROUND: Blunt force injuries in patients with preexisting kidney disease account for 19% of all kidney injuries, suggesting that diseased kidneys are more vulnerable than normal kidneys. When a horseshoe kidney (a rare anomaly: prevalence of 0.2%) is injured, treatment is challenging, especially when nonoperative management is desired. In high-grade blunt force normal kidney injury, nonoperative management has high succession rate (94.8%) with kidney-related complication (13.6%). Surgical reconstruction and preservation of a damaged horseshoe kidney is difficult because of variations in its vascular anatomy. We report successful nonoperative management of a blunt horseshoe kidney injury with active bleeding and review previous outcomes and complications. Case Presentation. A 57-year-old man had a head-on collision motorcycle road traffic accident. On arrival, blood pressure was 90/60 mmHg, pulse rate 140 bpm, and clear yellow urine output 200 ml. The patient was transiently responsive to fluid and blood component. Whole body computed tomography showed a high-volume retroperitoneal hematoma and multiple-lacerated lower pole of the kidney, compatible with preexisting horseshoe kidney disease with active contrast-enhanced extravasation from the accessory right renal artery. Embolization was performed. Renal function, transiently impaired after embolization, normalized on day 3. An infected hematoma found on day 7 was successfully controlled with antibiotics. His recovery was uneventful. At the 6-month follow-up, his serum creatinine level had returned to normal. The average age of blunt force horseshoe kidney injury is 31.75 years and occurred more common in male (87.5%). CONCLUSION: Diseased horseshoe kidneys are prone to injury even with low-velocity impact such as a road traffic accident speed < 15 km/h. Embolization is considered the first choice for management, with its high clinical success rate leading to less need for surgical repair. Not removing a hematoma is likely to result in complications. If embolization fails to stop bleeding, life-saving surgical exploration should be mandated.

How early is early? Effect of oxybutynin on bladder dynamics within the first year of life in patients with spina bifida.

INTRODUCTION: Early proactive treatment of patients with high-risk neurogenic bladder from spina bifida (SB) may preserve renal function and decrease the need for bladder augmentation later in life. Timing of initiation of anticholinergic therapy (AC) medication and clean intermittent catheterization (CIC) is variable and based on imprecise studies. The authors hypothesized that initiation of AC after the initial video-urodynamic study (VUDS) may benefit bladder capacity even in children who do not meet the standard hostile criteria for starting AC. STUDY DESIGN: A retrospective review of a prospectively maintained VUDS database from August 2015 to March 2019 was performed. Patients with SB who had undergone initial VUDS between 1 and 7 months of age and had a subsequent follow-up study between 9 and 18 months of age were included. Multiple VUDS and clinical parameters including expected bladder capacity, actual capacity reached, pressure at actual capacity, presence of detrusor overactivity, presence of urinary tract dilation and reflux, and whether or not AC was started were extracted and compared. P-value of <0.05 was considered statistically significant. RESULTS: A total of 69 patients completed an initial study at median age of 2 months, and follow-up study at median age of 13 months. Anticholinergic therapy was started in 21 patients (10 F, 11 M). Decision to initiate AC was at discretion of the attending pediatric urologist performing the VUDS in real time. Changes between the initial and repeat VUDS are listed in the summary table below. Adverse effects of AC were reported in 25% (5/21) patients: urinary retention/UTIs (3), allergic reaction (1), and fatigue (1). DISCUSSION: The authors findings suggest that AC stabilizes storage pressure for those who initially have a higher storage pressure, while in those with initial low storage pressures, storage pressures worsened over time in the absence of AC. Patients started on AC experienced a faster rate of increase in bladder capacity. Limitations to this study included the unknown long term and sustainability of the improvement in bladder parameters, the lack of uniform criteria for the initiation of AC or CIC, and an unknown long-term degree of upper tract protection. CONCLUSION: This study found early initiation of AC in SB at 2 months of age had significant positive effects on growth of bladder capacity and stabilization of storage pressure. However, long-term effects of AC are still undetermined, and thus, longitudinal studies are needed to understand the precise indications for initiation of early AC treatment.

Reduction in bacteremia rates after rectum sterilization before transrectal, ultrasound-guided prostate biopsy: a randomized controlled trial.

OBJECTIVE: To determine the efficacy of rectum sterilization before TRUS guided prostate biopsy in order to decrease bacteremia rate and sepsis complication. MATERIAL AND METHOD: From August 2008 to March 2009, 100 volunteers who had an indication for prostate biopsy were recruited into the present study in a randomized controlled trial. The present study was approved by the Ethics Committee on Human Experimentation of Ramathibodi Hospital Faculty of Medicine, Mahidol University. The volunteers received unison enema one day before and Ciprofloxacin 500 mg 0.5-1 hr before the procedure. These 100 volunteers were divided into two groups; 50 were randomly assigned in the group of rectum cleaning with 10% povidone-iodine, whereas the other 50 volunteers were placed in the control group. Twelve cores of TRUS guided prostate biopsy were performed After the procedure, peripheral blood samples were taken for cultures for aerobic and anaerobic bacteria. A clinical follow-up at 48-72 hrs after the procedure was done via telephone. RESULTS: Hemocultures were positive for 9 cases in the rectum cleaning group and 2 cases in the control group (p = 0.025). Three volunteers (one in the rectum cleaning group and two in the control group) had a postoperative fever but it spontaneously resolved. Two volunteers in the control group came back to the hospital because of urinary tract infections and rectal bleeding. None of the volunteers had clinical sepsis or went to other hospitals. CONCLUSION: Sterilization of the rectum before TRUS guided prostate biopsy was found to reduce postoperative bacteremia and might reduce clinical infections.

Transperineal repair of rectourethral fistula: surgical technique and a case report.

A 60-year old Thai male diagnosed as iatrogenic rectourethral fistula. Preoperative investigation with intravenous pyelogram revealed connection between urethra and rectum. Colonoscopy also revealed fistula opening at mid-rectum. He underwent surgery via transperineal approach. Intraoperative fistula localization was performed using Methylene blue injection via foley catheter. The fistula tract was identified and divided exposing blue-staining tract. Rectal opening and urethral opening were repaired Fecal and urthral diversion were performed Postoperative period was uneventful. The final pathologic report of fistula tract was fibrosis. The perineal and rectal wounds were healed without complication. The suprapubic cystostomy catheter was removed at the end of the second month together with the colostomy closure.

Colorimetric detection of PCA3 in urine for prostate cancer diagnosis using thiol-labeled PCR primer and unmodified gold nanoparticles.

BACKGROUND: PCA3, a non-coding RNA, has been approved as a potential urinary biomarker for prostate cancer. However, PCA3 urine tests have some limitations. Therefore, we developed a colorimetric method for PCA3 detection in urine. METHODS: The assay was based on interactions between unmodified gold nanoparticles (AuNPs) and thiolated PCR products. Thiolated PCR products were amplified by RT-PCR using a thiol-labeled primer at the 5' end. Thiolated products of PCA3 bound to the surface of AuNPs and led to the prevention of salt-induced aggregation (red color). In the absence of the PCR products, AuNPs changed their color from red to blue due to the salt-induced aggregation. These changes were detected by the naked eye and spectrophotometer. RESULTS: Our assay was specific for PCA3 in prostate cancer cell lines with a visual detection limit of 31.25 ng/reaction. The absorption ratio 520/640 nm was linear against PCR product concentration (R2 = 0.9798) in the reaction. This method is promising for discrimination of prostate cancer patients from both healthy controls and benign prostatic hyperplasia patients according to their urinary PCA3 expression levels. CONCLUSIONS: This study established a simple, rapid, sensitive and specific assay for PCA3 detection which may be applicable for prostate cancer diagnosis.

Reliability of a Thai version of King's Health Questionnaire in Thai females with overactive bladder symptoms.

OBJECTIVES: To develop and test the reliability of a Thai version of the King's Health Questionnaire (KHQ). MATERIAL AND METHOD: Three Thai Urologists forward translated the original English KHQ into a Thai version. Back translations were performed by an independent group of physicians. A consensus was reached on a final Thai version after comparing the original KHQ and various translations. Fifty Thai female patients with symptoms of overactive bladder were tested and retested every two weeks using the Thai version (twice) as well as the English version (once) of the KHQ. Test-retest reliability of the Thai questionnaire was measured using the kappa statistic. RESULTS AND CONCLUSION: The Thai version of the KHQ was found to be reasonably reliable for use in Thai female patients with over active bladder symptoms.

A randomized controlled trial of pubovaginal sling versus vaginal wall sling for stress urinary incontinence.

PURPOSE: To compare the results of Pubovaginal sling and Vaginal wall sling for the treatment of stress urinary incontinence in females. MATERIAL AND METHOD: Between February 2001 and December 2001, a randomized controlled trial was done to compare safety and efficacy of pubovaginal sling versus vaginal wall sling in the management of women with urinary incontinence. Fifteen women 42-68 years old (mean age 51.3 years) were treated with fascial sling (group A) and 11 women 45-60 years old (mean age 50.4 years) with vaginal wall sling (group B). Twenty-one patients had type II SUI and 5 patients had type III SUI (ISD); none had pre-operative detrusor instability. Measures of outcome included efficacy based on SEAPI-QMN, post-operative presence of stress or urge incontinence, frequency of complications, operative time, post-operative pain, length of hospitalization, length of clean intermittent catheterization (CIC) time and mean global evaluation. RESULTS: All patients were followed for at least 3 months after surgery (median 7 months). A total of 20 and 6 women received spinal and general anesthesia, respectively. SEAPI-QMN decreased from a median of 6.3 to 0.8 for group A and from 6.1 to 0.9 for group B. No patient in either group had persistent stress incontinence. Urge incontinence was present in 2 of group A patients and 1 of group B patients. No serious post-operative complications were encountered in both groups. Post-operative pain and operative times for group B patients were significantly lower than for group A patients. Length of hospitalization, length of CIC time and mean global evaluation were not significantly different between the two groups. CONCLUSION: In the short-term, both pubovaginal sling and vaginal wall slings were effective in the treatment of women with SUI. However, the use of vaginal wall sling resulted in significantly shorter operative times and lower post-operative pain compared with pubovaginal sling. Therefore, the vaginal wall sling should be the prefered treatment for SUI.