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.

Long-term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dysfunction.

INTRODUCTION AND HYPOTHESIS: To compare long-term lower urinary tract dysfunction after radical hysterectomy in patients with or without early postoperative voiding dysfunction. METHODS: Thirty patients at least 2 years after radical hysterectomy were evaluated with multichannel urodynamic studies. Fifteen patients (group A) had early postoperative voiding dysfunction (required urethral catheterization more than 1 month), and 15 patients (group B) had no early postoperative voiding dysfunction. RESULTS: Overall voiding dysfunction was more prevalent in group A than group B (73.3% versus 33.3%, p > 0.05). In particular, high postvoid residual urine and abdominal straining increased significantly in group A (40% versus 0% and 60% versus 13.3%, respectively). Total and all domains scores from Urogenital Distress Inventory and Incontinence Impact Questionnaire were not different between both groups. CONCLUSION: High postvoid residual urine and abdominal straining increased significantly in patients with early postoperative voiding dysfunction without impairment on quality of life.

Leiomyosarcoma of the renal pelvis diagnosed by percutaneous endoscopic resection.

We present a case of leiomyosarcoma arising from the renal pelvis, which is a rare clinical entity. A percutaneous endoscopic resection led to the final histopathological diagnosis. The patient underwent radical nephrectomy and did not receive adjuvant therapy. Based on follow-up CT scans, he remains recurrence-free one year after surgery.

Furosemide Stress Test as a Predicting Biomarker for Delayed Graft Function in Kidney Transplantation.

BACKGROUND: Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF. MATERIALS AND METHODS: This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986-0.999, p = 0.035) for the 4-h urine volume to predict DGF. CONCLUSIONS: The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.

IQOL: translation & reliability for use with urinary incontinence patients in Thailand.

BACKGROUND AND OBJECTIVE: Urinary incontinence is consistently associated with an adverse effect on the quality of life (QoL) for patients. The I-QOL is a self-report quality-of-life measure specific to urinary problems that can be used to assess the impact of urinary incontinence and urinary problems (such as overactive bladder without incontinence) and their treatment. The objectives of the present study were to develop and test the reliability of a Thai version of the Incontinence Quality of Life Questionnaires (IQOL). MATERIAL AND METHOD: The I-QOL was formally translated from the original version to the Thai language with Permission. The translation process included forward translation by 2 translators. Cultural and linguistic modifications ofbothforward versions were done by a group of urologists who had extensive experience in the management of urinary incontinence. Another two Thai-English translators performed the back translation into English. Enrolled subjects included urinary incontinence patient and normal subjects were asked to complete the translated versions of I-QOL and repeated the same two weeks apart for test-retest analysis. Reliability was determined from Cronbach's alpha (reliability coefficient). Pearson's correlation was used to assess test-retest reliability. RESULTS: A 22 items questionnaire was developed. Sixty patients with urinary incontinence and fifty normal subjects were enrolled into the present study. Mean ages (SD) of patients with incontinence and controlled groups were 52.42(13.54) and 48.22(10.27) years. Of the 60 patients with urinary problems, 15(13.6%) had stress urinary incontinence (SUI), 17(15.5%) had overactive bladder (OAB), 13(11.8%) had mixed urinary incontinence, 15(13.6%) had urge urinary incontinence from BPH. The mean scores(SD) of I-QOL in the normal group was 89.63(12.64) and 57.65(20.04) in the urinary incontinence group. Cronbach's alpha of the overall IQOL scores was 0.96. Test-retest reliability done at 2 weeks apart was 0.905. CONCLUSION: The translated I-QOL is valid and applicable in Thais with urinary incontinence problems. I-QOL score reveals that QOL in these patients is lower than that in the normal population.

Case report of voiding difficulty after intravaginal slingplasty (IVS) procedure: the emphasize of pre-service training.

BACKGROUND: The Intravaginal slingplasty procedure (IVS) is a minimally invasive surgery for the treatment of stress urinary incontinence (SUI). Too much tension during pulling the tape and the incorrect placing of the tape can cause urinary retention that may require release of the tape. CASE REPORT: A fifty one years old women with SUI had undergone IVS procedure in a private hospital. After the surgery, urinary retention occurred with prolonged catheterization for 20 days. The patient came to King Chulalongkorn Memorial Hospital on the 21st day after the operation. Surgical release of the tape which was located at the urethrovesical junction rather than the midurethera was done. The patient remained stress continent after the tape was released confirmed by the videourodynamic study one month later. CONCLUSION: Too much tension, insertion of the tape too close to the urethrovesical junction or the tape migration may be the causes of prolonged urinary retention after IVS procedure. The authors found the surgical release of the tape to be the effective management for this complication. Pre-service training in models and practice under the supervision of an experienced surgeon are needed before attempting any on their own. From the authors extensive review, this is the first case report of urinary retention after IVS procedure that required tape incision.

The three years results of tension free vaginal tape (TVT) for the treatment of stress urinary incontinence in Thai women.

OBJECTIVE: To evaluate the three years result of TVT procedure in Thai women with genuine stress urinary incontinence (SUI). MATERIAL AND METHOD: Sixty three women, aged 35 - 71 years attending the gynecology clinic at King Chulalongkorn Hospital from February 2000 to May 2001 were recruited in the present study. Pre-operative evaluation included history taking and physical examination. All had stress urinary incontinence urodynamically confirmed genuine stress urinary incontinence and were treated with TVT Follow up at 3, 6, 12, 18, 24, 30 and 36 months were scheduled after surgery. RESULTS: The mean +/- SD of operative time for TVT was 32.3 +/- 10.0 min the mean +/- SD of hospitalization was 1.8 +/- 2.0 days. Two patients had bladder perforations by the trocar without severe bleeding and needed no reparation. No healing defect or rejection of the prolene mesh was found. The cure rate and improved rate were 95.2% and 4.8% respectively (60 from 63 cases) at 3 years follow up. CONCLUSION: The three years results revealed that TVT was effective and safe in the treatment of SUI in Thai women.

Long term results of anterior colporrhaphy with Kelly plication for the treatment of stress urinary incontinence.

OBJECTIVE: To study the five years' outcome of anterior colporrhaphy with Kelly plication for the treatment of stress urinary incontinence MATERIAL AND METHOD: Fifty two patients who underwent anterior colporrhaphy with Kelly plication with or without posterior colpoperineorrhapy for the treatment of stress urinary incontinence between January 1997 and February 1998 in King Chulalongkorn Memorial hospital were included in the study. All patients were contacted by phone, forty seven patients (90.38%) responded and were willing to participate in the present study. The patients' characteristics, operative data and outcome were reviewed. Questionnaires designed to assess the outcomes of the procedure and incontinence symptoms were given to each patient at the appointment date. Pelvic examination was performed using the Baden halfway classification for genital prolapse grading. Cough test was performed during pelvic examination for the objective demonstration of stress incontinence. RESULTS: The mean +/- SD of age was 46.68 +/- 8.78 yrs. The authors found that the incidence of post operative urinary retention was 43.3%. Incontinence rates at 1, 2, 3, 4 and 5 years were 0, 8.51%, 21.28%, 29.79% and 46.81% respectively. CONCLUSION: The present results show the high recurrence rate at the five-year follow up. The authors emphasized the need of long term follow up and pre-operative counseling about the high chance of having recurrence by this operative technique.