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.

Radical prostatectomy outcomes in renal transplant recipients: a retrospective case series of Thai patients.

BACKGROUND: The incidence of prostate cancer in renal transplant recipients (RTR) is similar to the general population. Radical prostatectomy (RP) is the standard of care in the management of clinically localized cancer, but is considered complicated due to the presence of adhesions, and the location of transplanted ureter/kidney. To date, a few case series or studies on RP in RTR have been published, especially in Asian patients. This study aimed to evaluate the efficacy and safety and report the experience with RP on RTR. METHODS: We retrospectively reviewed data of 1270 patients who underwent RP from January 2008 to March 2020, of which 5 patients were RTR. All available baseline characteristics, perioperative and postoperative data (operative time, estimated blood loss (EBL), complications, length of hospital stay, complication), pathological stage, Gleason score, surgical margin status, and pre/postoperative creatinine were reviewed. RESULTS: Of the 5 RTR who underwent RPs (1 open radical prostatectomy (ORP), 1 laparoscopic radical prostatectomy (LRP), 2 robotic-assisted laparoscopic radical prostatectomies (RALRP), and 1 Retzius-sparing RALRP (RS-RALRP)) prostatectomy, the mean age (± SD) was 70 (± 5.62) years. In LRP and RALRP cases, the standard ports were moved slightly medially to prevent graft injury. The mean operative time ranged from 190 to 365 min. The longest operative time and highest EBL (630 ml) was the ORP case due to severe adhesion in Retzius space. For LRP and RALRP cases, the operative times seemed comparable and had EBL of ≤ 300 ml. All RPs were successful without any major intra-operative complication. There was no significant change in graft function. The restorations of urinary continence were within 1 month in RS-RALRP, approximately 6 months in RALRP, and about 1 year in ORP and LRP. Three patients with positive surgical margins had prostate-specific antigen (PSA) persistence at the first follow-up and 1 had later PSA recurrence. Two patients with negative margins were free from biochemical recurrence at 47 and 3 months after their RP. CONCLUSIONS: Our series suggested that all RP techniques are safe and feasible mode of treatment for localized prostate cancer in RTR.

Symptom prevalence, bother, and treatment satisfaction in men with lower urinary tract symptoms in Southeast Asia: a multinational, cross-sectional survey.

PURPOSE: The overall objective of the survey was to systematically examine patients' perspectives on lower urinary tract symptoms (LUTS) and their treatment in Southeast Asia. METHODS: A multinational cross-sectional survey involving adult men seeking consultation at urology outpatient clinics because of LUTS in Southeast Asia was conducted using convenience sampling. Self-reported prevalence, bother, treatment and treatment satisfaction of selected LUTS including urgency, nocturia, slow stream, and post-micturition dribble were evaluated. RESULTS: In total, 1535 eligible patients were enrolled in the survey. A majority of respondents were aged 56-75 years, not employed, and had not undergone prostate operation before. Overall, the self-reported prevalence of nocturia was 88% (95% CI 86-90%), slow stream 61% (95% CI 59-63%), post micturition dribble 55% (95% CI 52-58%), and urgency 52% (95% CI 49-55%). There were marked differences in the country specific prevalence of LUTS complaints. Frequently, symptoms coexisted and were combined with nocturia. More than half of patients felt at least some degree of bother from their symptoms: 61% for urgency, 57% for nocturia, 58% for slow stream, and 60% for post-micturition dribble. Before seeing the present urologists, nearly half of patients have received some form of prescribed treatment and more than 80% of patients indicated they would like to receive treatment. CONCLUSION: Men who sought urologist care for LUTS often presented with multiple symptoms. Nocturia emerged as the most common symptom amongst the four core symptoms studied.

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.

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.

Estrogen and progesterone receptors in patients with bladder pain syndrome.

OBJECTIVE: Analyze if bladder mucosa of patients with bladder pain syndrome (BPS) have more estrogen receptor (ER) and progesterone receptor (PR) than the normal population. MATERIAL AND METHOD: Between July 2009 and December 2010, 15 female patients with chronic bladder pain syndrome and 10 female patients without bladder pain were enrolled in the present study. Three pieces of trigonal bladder mucosa were biopsied and sent for estrogen receptor and progesterone receptor immunohistochemistry staining by the Benchmark automated machine. The results were reported as positive and negative and then compared between the two groups. RESULTS: Estrogen receptor was found in 14 out of 15 patients in the BPS group (93%) and in 7 out of 10 patients in the control group (70%). Progesterone receptor was found in 10 out of 15 patients in the BPS group (66.7%) and 5 out of 10 patients in the control group. Both were not significantly different with p = 0.267 and p = 0.678, respectively. CONCLUSION: The authors concluded that ER and PR might not play a role in the etiopathogenesis of BPS/IC. However other receptors should be further investigated about their role in this type of pain.

Complications prevention of shoulder balance support device for lateral decubitus position: A randomized controlled trial.

Objectives: The authors invented the shoulder balance support device aiming to prevent skin complications and neck pain in surgical patients operated in lateral decubitus position. This study aimed to compare skin complications and neck pain between patients with shoulder balance support device and traditional positioning instruments and to assess surgeons' and anesthesiologists' satisfaction in using the device. Methods: A randomized controlled trial, which followed Consolidated Standards of Reporting Trials(CONSORT) statement, was conducted in patients who underwent laparoscopic upper urinary tract surgery in the lateral decubitus position from June 2019 to March 2021. The shoulder balance support device was used in 22 patients and 22 other patients were in the control group. The area of skin erythema, bruising, or abrasion resulting from the pressure effect of the lateral decubitus position was measured and the pain score for the neck and shoulder area after the operation was assessed. Furthermore, the satisfaction of the medical personnel taking care of the patients and using the shoulder balance support device was investigated. Results: A total of 44 patients were included. No patient in the intervention group reported neck pain. Skin erythema was found in six patients in each group and the median area of skin erythema was significantly smaller in the intervention group. Most of the medical personnel reported satisfaction with use of the device. Conclusion: This device is an innovative tool with the aim of ultimate care for surgical patients. Clinical Trial Registration Number: Thai Clinical trials registry ID TCTR 20190606002.

PSA density and prostate cancer detection.

OBJECTIVE: To evaluate the diagnostic value of prostate-specific antigen density (PSAD) and the appropriate cutoff for the detection of prostate cancer. MATERIAL AND METHOD: Between January 2008 and March 2011, 292 men with PSA levels between 4 and 10 ng/mL underwent transrectal ultrasonography (TRUS) with prostate biopsy. The diagnostic value of PSA levels and PSAD were compared using receiver operating characteristic curves. RESULTS: Prostate cancer was diagnosed in 64 (22%) of the 292 men who had PSA levels 4 to 10 ng/mL. The mean PSA level was 6.96 ng/mL. The mean age was 66 years. The area under the curve (AUC) of PSA and PSAD were 0.475 and 0.665, respectively. The sensitivity and specificity of PSAD at cutoff of 0.15 was 78% and 43%, respectively CONCLUSION: PSAD was a better discriminator of prostate cancer than PSA for PSA levels less than 10 ng/ml. Our data suggested that a different PSAD cutoff than previously recommended need to be defined for Thai people.

Comparison of extraperitoneal laparoscopic radical prostatectomy and open retropubic radical prostatectomy at Ramathibodi Hospital, Thailand: a retrospective review.

OBJECTIVE: To compare perioperative outcomes of open radical retropubic prostatectomies (O-RRP) and extraperitoneal laparoscopic radical prostatectomies (E-LRP), focusing on operative time, blood loss, length of hospital stay, time to drain removal, and surgical margin status. MATERIAL AND METHOD: The authors reviewed the medical histories of 173 patients treated for prostate cancer by radical prostatectomy at Ramathibodi Hospital between January 1997 and August 2010. Eighty-one patients were treated with O-RRP and 52 were treated with E-LRP The remaining forty cases were omitted from the present study due to incomplete data (such as incomplete operative note, history) or if the patient had post transurethral prostatectomy or post androgen deprivation therapy Open radical retropubic prostatectomies were performed by two experienced surgeons, and laparoscopic extraperitoneal radical prostatectomies were performed by a single surgeon. The following data were collected and compared between treatments, operative time, blood loss, length of hospital stay, time to drain removal, and surgical margin status. RESULTS: Preoperative patient data indicated that both groups were comparable in age, height, prostate-specific antigen (PSA) levels, and Gleason scores from transurethral ultrasound guided biopsy. However, body weight and BMI was significantly higher in the O-RRP group. Estimated blood loss was significantly lower in the E-LRP group (median = 600 ml, range = 50-4,000 ml) than in the O-RRP group (median = 2,000 ml, range 200-7,500 ml) (p < 0.001). The length of hospital stay in the E-LRP group (median = 8 days, range = 4-27 days) was significantly shorter than in the open group (median = 11 days, range = 5-37 days) (p < 0.001). There were no significant differences between operative times, times to drain removal, or surgical margin statuses. CONCLUSION: The present study shows that patients who underwent E-LRP experienced less blood loss and shorter hospital stays than patients who underwent O-RRP.

Ultrastructural study of the detrusor in end stage renal disease.

BACKGROUND: After successful renal transplantation, almost 50% of the patients complained of lower urinary tract symptoms. There is no definite conclusion to explain these voiding symptoms and ultrastructural study of detrusor muscle in end stage renal disease (ESRD) has never been carried out before. OBJECTIVE: To study ultrastructural changes of detrusor muscle in the specific group of patients with end stage renal disease. MATERIAL AND METHOD: Detrusor biopsy of 20 patients, including 15 in end stage renal disease and five in patients with normal creatinine, was obtained by open technique. Biopsy was done during ureteral reimplantation at the time of kidney transplantation. In normal renal function group, detrusor biopsy was done at the time of open bladder surgery from other urologic diseases. The specimens were processed for light microscopy and transmission electron microscopy using standard techniques. RESULTS: All specimens from open biopsy provided sufficient quality to be examined by electron microscope. The average creatinine level was 9.2 and 1.0 mg/dl in the ESRD group and control group, respectively In the ESRD group, all showed hypertrophy of muscle bundles, fibrosis between muscle bundles, muscle bundle degeneration, and fragmentation of muscle cells. In ESRD group, 93% had fibrosis around nerve bundles and enlarged muscle cell nuclei. About 60% had enlarged nerve bundles, and 53% showed amorphous inclusion in muscle cells. The ESRD group displayed many more ultrastructural changes than in the control group and some appearances were not present in the control group. CONCLUSION: There were distinct ultrastructural changes of detrusor muscles in ESRD patients. These ultrastructural changes of detrusor muscles may be associated with voiding dysfunction after kidney transplantation.

Efficacy of the Orally Disintegrating Strip Sildenafil for the Treatment of Erectile Dysfunction: A Prospective, Randomized Trial.

INTRODUCTION: Phosphodiesterase 5 inhibitors are the predominant treatment option for erectile dysfunction. AIM: This study evaluates the efficacy and safety of sildenafil orally disintegrating strips for the treatment of erectile dysfunction. METHODS: One hundred twenty erectile dysfunction patients were enrolled in a prospective, randomized, controlled crossover study and allocated into 2 groups of 60 participants. Patients were either treated with sildenafil strips or tablets for 8 weeks after which they crossed over into the alternate treatment formulation for another 8 weeks following a 4-week wash-out period. Each participant was assessed 8 times throughout the study period and their formulation preference registered at the end of the study. MAIN OUTCOMES AND MEASURES: Changes in the abridged International Index of Erectile Function (IIEF-5) score and Erection Hardness Score (EHS) resulting from sildenafil orally disintegrating strip or tablet treatments were the primary end points, with differences in onset of action, duration of action, and incidence of adverse events between the 2 formulations included as secondary end points. RESULTS: Both sildenafil formulations were effective in treating patients with erectile dysfunction. There was significant improvement of erectile function in term of IIEF-5 score and EHS from both formulations. The number and type of adverse events were also comparable. Likewise, there were no statistically significant differences between the earliest onset of action times and longest duration of action times. However, the results showed a 7.1-minute earlier onset of action time for orally disintegrating strips that may be considered as clinically meaningful by some patients. CONCLUSION: Sildenafil orally disintegrating strips are a safe and effective alternative to the conventional tablet formulation for the treatment of erectile dysfunction. Sangkum P, Sirisopana K, Matang W, et al. Efficacy of the Orally Disintegrating Strip Sildenafil for the Treatment of Erectile Dysfunction: A Prospective, Randomized Trial. Sex Med 2021;9:100453.

Neoadjuvant Androgen Deprivation Therapy Effects on Perioperative Outcomes Prior to Radical Prostatectomy: Eleven Years of Experiences at Ramathibodi Hospital.

OBJECTIVE: The aim of this study was to demonstrate the efficacy of neoadjuvant androgen deprivation therapy (NADT) on perioperative outcomes in patients who underwent radical prostatectomy (RP). MATERIALS AND METHODS: From January 2008 to July 2018, we collected retrospective data of patients with clinically localized prostate cancer who underwent RP to assess their perioperative and pathological outcomes. The data included age, body mass index (BMI), serum prostate specific antigen (PSA) level, clinical stage, neoadjuvant ADT usage, operative time, estimated blood loss (EBL), perioperative complications, blood transfusion rate, adjacent organ injury rate, length of hospital stay, pathological stage, Gleason score (GS) of the biopsy and pathological specimen, specimen weight (g), and margin status. RESULTS: Of the 718 RPs performed, 138 (19.22%) were NADT and 580 (80.78%) were non-NADT. Patients who underwent NADT had a significant benefit in operative time (185 vs 195 mins), EBL (300 vs 500 mL) and specimen weight. These benefits were more obvious in non-low risk prostate cancer with less operative time, EBL, blood transfusion rate, length of hospital stay and specimen weight. However, the margin status and adjacent organ injury rate were similar in the NADT and non-NADT groups. CONCLUSION: NADT provides significantly better perioperative outcomes, especially in non-low risk prostate cancer, and has comparable pathological outcomes.

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.

Perioperative outcomes of robotic-assisted laparoscopic radical prostatectomy, laparoscopic radical prostatectomy and open radical prostatectomy: 10 years of cases at Ramathibodi Hospital.

BACKGROUND: This study aims to compare the perioperative and pathological outcomes of open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic radical prostatectomy (RALRP) at Ramathibodi Hospital within Mahidol University in Thailand. METHODS: From January 2008 to July 2017, 679 RPs were performed. Patients' data were collected retrospectively to evaluate their perioperative and pathological outcomes. This data included the age, body mass index (BMI), serum prostate specific antigen (PSA) level, clinical stage, Gleason score (GS) from biopsy, operative time, estimated blood loss (EBL), perioperative complications, blood transfusion rate, adjacent organ injury rate, length of hospital stay, pathological stage, GS of the biopsy specimen, specimen weight (g), and marginal status of the patients. RESULTS: Of the 679 RPs performed, 128 (19.28%) were ORPs, 241 (36.30%) were LRPs, and 295 (44.43%) were RALRPs. Patients who underwent a RALRP had a significant advantage in EBL (1,600, 500, and 300 mL for ORPs, LRPs, and RALRPs, respectively), overall complications, and blood transfusion rate. As they are minimally invasive techniques, LRP and RALRP presented an advantage in terms of the length of hospital stay (an average of 9, 6, and 6 days for ORPs, LRPs, and RALRPs, respectively) and adjacent organ injury rate. ORPs also had the shortest operative time (160, 210, and 200 min for ORPs, LRPs, and RALRPs, respectively). However, the specimen weight and marginal status were similar in all of the techniques. CONCLUSIONS: Minimally invasive RP techniques, such as LRPs and RALRPs, appear to be safe, have significantly better perioperative outcomes than ORPs, and have comparable pathological outcomes to those of ORPs.

Foreign bodies in the female urinary bladder: 20-year experience in Ramathibodi Hospital.

OBJECTIVE: Foreign bodies in the female urinary bladder may occur by self-insertion or migration from adjacent organs. The most common reason for this is sexual in nature, but hygienic behaviour and attempts to relieve voiding problems have been reported. Only small case series were found in the literature devoted to foreign bodies in the urinary bladder. Therefore, we reviewed our experience regarding foreign bodies in the female urinary bladder in our hospital. METHODS: Medical records of female patients who were diagnosed with a foreign body in the urinary bladder during 1985-2005 were reviewed. Demographics, causes, type of object found, clinical presentation, treatment and outcomes were noted. RESULTS: Seventy-eight patients with a mean age of 38 years were identified. The major route for ingress of foreign bodies was via the urethra. The objects found self-inserted were cotton swabs, tampons, paper clips and pen casings. As most of Thailand is an agricultural environment, some small living organisms such as leeches could be found as foreign bodies in the bladder. The majority of the cases presented with haematuria associated with frequency, urgency and pelvic pain. Almost all cases could be managed by endoscopic removal with minimal complications. Four cases were treated by open surgery. CONCLUSION: Foreign bodies in the urinary bladder represent a urological challenge that requires prompt management. The suspected history and presenting symptoms are crucial and lead to further investigations. Gentle endoscopic management is the main treatment with a high success rate.

A new dimension in vesicovaginal fistula management: an 8-year experience at Ramathibodi hospital.

OBJECTIVE: Vesicovaginal fistula is mostly iatrogenic in origin and causes devastating medical, social, psychogenic and hygienic consequences. The aetiology has changed since the nineteenth century, becoming more associated with hysterectomy rather than other obstetric procedures, which were common in the past. We studied the causes, clinical presentations and management of vesicovaginal fistula in our institute during 1998 to 2005. METHODS: From 1998 to 2005, 45 patients were treated in our hospital, of whom 35 were referred from other hospitals after failed surgery. All the medical records were reviewed. Fistulae, clinical presentation, clinical findings, means of treatment and clinical outcome as well as complications were noted. RESULTS: The most common cause of a fistula in our study was post laparoscopic hysterectomy that comprised 28 cases (62.2%). Transabdominal hysterectomy caused fistula in 10 cases (22.2%) and vaginal hysterectomy only four cases (8.8%). Most cases of vesicovaginal fistulae after laparoscopic hysterectomy presented with early urinary leakage, of which 35.7% presented within 1 week and 50% in the second week. Most of the patients after transabdominal hysterectomies (90%) had leakage in the second week. All patients were treated with surgical repair, 19 cases by a transvaginal approach and 26 cases by a transabdominal repair. Seventeen cases in the transvaginal group and 25 cases in the transabdominal group were dry after the first operation. The rest of both groups were dry after the second operation. After 38 months of follow-up, no complication or incontinence was noted. CONCLUSION: Vesicovaginal fistula is still a serious iatrogenic consequence and causes suffering in the physical, emotional and social functioning of patients. The study found that the condition is now more frequently associated with laparoscopic hysterectomy. Successful closure of the fistula requires an accurate and timely repair using procedures that exploit basic surgical principles. With the appropriate surgical expertise, all patients can be cured of this distressing condition.

Efficacy of tamsulosin in the treatment of lower urinary tract symptoms (LUTS) in women.

OBJECTIVE: We attempted to determine whether tamsulosin is an efficacious therapy for the treatment of lower urinary tract symptoms (LUTS) in women. METHODS: A total of 140 women, aged 27-69 years old with LUTS entered a randomized double-blind study comparing tamsulosin (70) versus placebo (70) for 1 month. The outcome variables were mean change from baseline of International Prostate Symptom Score (IPSS), mean change from baseline of mean and maximum urinary flow rate and any adverse effects. RESULTS: Mean change from baseline of IPSS (standard deviation, SD) were -5.6 (6.3) in the tamsulosin group and -2.6 (6.1) in the placebo group. The difference was statistically significant (p = 0.008). Mean change from baseline of mean urinary flow rate (SD) was 0.7 (2.7) mL/second in the tamsulosin group and -0.5 (2.6) mL/second in the placebo group. The difference was also statistically significant (p = 0.013). However, the difference in mean change from baseline of maximum urinary flow rate between the two groups was not statistically significant (p = 0.506). There were two patients in the tamsulosin group who experienced dizziness and asthenia. No other adverse effect was detected. CONCLUSION: Tamsulosin is more efficacious than placebo in the treatment of LUTS in women.

Urinary risk factors for recurrent calcium stone formation in Thai stone formers.

OBJECTIVE: To survey the urinary risk factors associated with recurrent calcium stone and the contribution of renal tubular acidosis to the prevalence of recurrent calcium stone formation in Thai recurrent stone formers. MATERIAL AND METHOD: There were 86 consecutive recurrent calcium stone formers. Three-day dietary record, serum biochemical parameters, first morning urine pH, and two 24-hour urine collections were obtainedfrom each subject. Urinary risk factors for calcium stone formation were determined from the average of the 2-day urine collection. Normal controls were 34 subjects matched for aged, sex, and weight, and without a history of renal stone formation. RESULTS: Seven patients (8.1%) were diagnosed as incomplete renal tubular acidosis (iRTA). Among the 79 idiopathic calcium stone formers (ISF), 69.6%, 15.2%, 10.1%, 7.2% and 1.3% of patients were hypocitraturia, hypercalciuria, low urinary volume, hyperuricosuria and hyperoxaluria, respectively. The common combinations of risk factors were hypocitraturia plus low urine output (8.9%) or plus hypercalciuria (7.6%). There were significant differences between ISF and normal controls in urinary oxalate excretion (0.16 +/- 0.01 vs 0.12 +/- 0.01, p < 0.05), urinary calcium/citrate ratio (4.49 +/- 0.50 vs 2.83 +/- 0.34, p < 0.01) and ion activity product for calcium oxalate stone (0. 46 +/- 0.03 vs 0. 33 +/- 0.03, p < 0. 05). Urinary citrate in ISF varied directly with net alkaline absorption (r = 0.34, p < 0.005) and urinary potassium (r = 0.54, p < 0.001). There were significant correlations between urinary calcium excretion and both sodium excretion (r = 0.42, p < 0.001) and urea excretion (r = 0.41, p < 0.001) in ISE There were seven (8.1%) with incomplete renal tubular acidosis. Patients with iRTA tended to have less urinary citrate and higher calcium/citrate ratio than did ISF, but hypercalciuria was uncommon. CONCLUSIONS: Hypocitraturia was the most common urinary risk factor found in Thai recurrent idiopathic calcium stone formers followed by hypercalciuria and low urinary volume. Almost one-fourth of the stone formers had multiple risk factors. Hypocitraturia might result from low potassium and low alkaline intake. iRTA was common among recurrent calcium stone formers. Determination of morning urine pH should be a part of the investigations for urinary risk factors to avoid overlooking the diagnosis of iRTA.

Diagnostic accuracy of MRI/MRSI for patients with persistently high PSA levels and negative TRUS-guided biopsy results.

OBJECTIVE: To prospectively evaluate the accuracy of transrectal ultrasonographic (TRUS)-guided biopsies by using combined magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) in patients with persistently high prostate-specific antigen (PSA) levels and negative TRUS-guided biopsy results. MATERIAL AND METHOD: Twenty-one patients (age range 50-77 years, average 61.4 years) with negative TRUS biopsy were enrolled Suspicious areas were identified by discrete low signal intensity in T2 on standard MRI. MRSI was interpreted by using spectral approach and given score of I (benign) to 5 (malignant). Suspicious voxels were localized for guided TRUS biopsy. All patients underwent sextant TRUS biopsies with up to four additional biopsies targeted at suspicious sites. Diagnostic accuracy of MRI/MRSI in patient-by-patient and voxel-by-core were analyzed. RESULTS: Prostate cancer was detected in 2 of 21 patients (9.5%). The sensitivity, specificity, PPV, NPV and accuracy of combined MRI/MRSI for detection of prostate cancer were 100%, 84%, 40%, 100%, and 86%, respectively. The site of positive biopsy correlated correctly with voxels were 80%, 85%, 21%, 99% and 85% on sensitivity, specificity, PPV, NPV and accuracy, respectively. CONCLUSION: MRI/MRSI have the potential to guide biopsy to cancer foci in patients with persistently high PSA levels and prior negative TRUS biopsy results.

Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary potassium excretion.

BACKGROUND: Multiple factors associated with hypocitraturia have been identified. However, limited studies addressing the causal relationship to hypocitraturia are available. We therefore conducted this study to determine factors associated with hypocitraturia and show their causal relationship in recurrent calcium stone formers. METHODS: Dietary review and 24-hour urine samples were obtained from all recurrent calcium stone formers referred for metabolic workup in the stone clinic. One month of oral potassium chloride supplementation was prescribed to stone formers to determine the causal relationship between urinary potassium and citrate levels. RESULTS: Eighty-three subjects, 44 men and 39 women, were recruited to participate in this study. Hypocitraturia (citrate < 300 mg/d [<1.43 mmol/d]) was found in 50.6% of subjects. Four independent urinary variables associated with hypocitraturia were identified, including potassium level, net gastrointestinal alkaline absorption, calcium level, and titratable acid. Urinary potassium level was the strongest predictor of urinary citrate level. Hypocitraturic subjects also had lower fruit intake compared with subjects with high urinary citrate levels. Potassium chloride supplementation to a subgroup of this population (n = 58) resulted in a significant increase in urinary citrate excretion (350.73 +/- 27.25 versus 304.15 +/- 30.00 mg/d [1.67 +/- 0.13 versus 1.45 +/- 0.14 mmol/d]; P < 0.02), but no alteration in fractional excretion of citrate (19.7% +/- 2.7% versus 23.1% +/- 2.4%; P > 0.05). CONCLUSION: Hypocitraturia was found to be a common risk factor associated with recurrent calcium stone formation and low urinary potassium level, low alkaline absorption, low urinary calcium level, and high titratable acid excretion. Hypocitraturia is predominantly of dietary origin. Estimation of fruit intake should be included in the metabolic evaluation for recurrent calcium stone formation.