Comparative study of mobile acoustic uroflowmetry and conventional uroflowmetry: A systematic review and meta analysis.

INTRODUCTION: Uroflowmetry is a noninvasive measurement of the volume of urine excreted over time. Conventional uroflowmetry has become the main modality of urine flow measurement within time. However, this method requires the patient to be present in the hospital or healthcare setting, thus sometimes making the patients feel uncomfortable to undergo the examination. This led to multiple measurements which are inconvenient for the patients. Mobile acoustic uroflowmetry (sono-uroflowmetry) has been proposed as an alternative method of urine flow measurement due to its portability. This study aimed to evaluate the accuracy and reliability of sono-uroflowmetry as compared to conventional uroflowmetry. METHODS: Electronic databases searching were done using prespecified search strategy to retrieve articles related with uroflowmetry. In addition, hand-search strategy was used to identify additional articles. Studies with participants who had undergone sono-uroflowmetry were included. Voided volume, voiding duration, maximum flow rate, and average flow rate were identified and used to determine the outcomes of measurement. The quality of included articles was conducted using checklist for Diagnostic Test Accuracy Studies by JBI. RESULTS: Initial search yielded 335 articles with four additional papers identified through hand-searching process. Six papers were retrieved and further used in the narrative synthesis. Five studies enrolled male participants, while only one of the papers enrolled female participants as additional subgroup analysis. Therefore, the meta-analysis was performed by using only male participants. Based on the meta-analysis results, there were strong to very strong positive correlation in voided volume, voiding time, average flow, average flow rate, and maximum flow rate between sono and conventional uroflowmetry. CONCLUSION: Sonouroflowmetry showed significant positive correlations to conventional uroflowmetry, signifying its use as an alternative of conventional uroflowmetry.

Digital Pattern Recognition for the Identification of Various Hypospadias Parameters via an Artificial Neural Network: Protocol for the Development and Validation of a System and Mobile App.

BACKGROUND: Hypospadias remains the most prevalent congenital abnormality in boys worldwide. However, the limited infrastructure and number of pediatric urologists capable of diagnosing and managing the condition hinder the management of hypospadias in Indonesia. The use of artificial intelligence and image recognition is thought to be beneficial in improving the management of hypospadias cases in Indonesia. OBJECTIVE: We aim to develop and validate a digital pattern recognition system and a mobile app based on an artificial neural network to determine various parameters of hypospadias. METHODS: Hypospadias and normal penis images from an age-matched database will be used to train the artificial neural network. Images of 3 aspects of the penis (ventral, dorsal, and lateral aspects, which include the glans, shaft, and scrotum) will be taken from each participant. The images will be labeled with the following hypospadias parameters: hypospadias status, meatal location, meatal shape, the quality of the urethral plate, glans diameter, and glans shape. The data will be uploaded to train the image recognition model. Intrarater and interrater analyses will be performed, using the test images provided to the algorithm. RESULTS: Our study is at the protocol development stage. A preliminary study regarding the system's development and feasibility will start in December 2022. The results of our study are expected to be available by the end of 2023. CONCLUSIONS: A digital pattern recognition system using an artificial neural network will be developed and designed to improve the diagnosis and management of patients with hypospadias, especially those residing in regions with limited infrastructure and health personnel. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42853.

The Use of Interdigitating Y-Flap Technique for Imperforate Hymen.

Imperforate hymen is a rare condition affecting 1 of 2,000 women worldwide. Its treatment is surgical hymenectomy to relieve obstruction and reduce the risk of secondary endometriosis. Current surgical techniques for imperforate hymen pose risks of postoperative complications such as stenosis and ascending infection; thus, a new technique is needed. A case of a 12-year-old girl with a progressively bulging mass was presented. Physical examination revealed hematocolpos due to imperforate hymen. Surgery, using interdigitating Y-flap technique, was performed on the patient. The surgical outcome was satisfactory, and no postoperative complication was found during a follow-up visit.

The impact of silver nanoparticles on microbial communities and antibiotic resistance determinants in the environment.

Nanosilver (NAg) is currently one of the major alternative antimicrobials to control microorganisms. With its broad-spectrum efficacy and lucrative commercial values, NAg has been used in medical devices and increasingly, in consumer products and appliances. This widespread use has inevitably led to the release and accumulation of the nanoparticle in water and sediment, in soil and even, wastewater treatment plants (WWTPs). This Article describes the physical and chemical transformations of NAg as well as the impact of the nanoparticle on microbial communities in different environmental settings; how the nanoparticle shifts not only the diversity and abundance of microbes, including those that are important in nitrogen cycles and decomposition of organic matters, but also their associated genes and in turn, the key metabolic processes. Current findings on the microbiological activity of the leached soluble silver, solid silver particulates and their respective transformed products, which underpin the mechanism of the nanoparticle toxicity in environmental microbes, is critically discussed. The Article also addresses the emerging evidence of silver-driven co-selection of antibiotic resistance determinants. The mechanism has been linked to the increasing pools of many antibiotic resistance genes already detected in samples from different environmental settings, which could ultimately find their ways to animals and human. The realized ecological impact of NAg calls for more judicial use of the nanoparticle. The generated knowledge can inform strategies for a better 'risks versus benefits' assessment of NAg applications, including the disposal stage.

The Profile of COVID-19 in Patients with Autoimmune Disease: A Case Series.

Autoimmune diseases are known to be a risk factor for severe COVID-19 infection. This is the first case series of patients with autoimmune disease suffering from COVID-19 infection in Jakarta, Indonesia. There were 12 confirmed cases of COVID-19 infection in autoimmune patients from March 2020 until February 2021. We select 5 patients in this case series. Three of them had systemic lupus erythematous (SLE), one of them had rheumatoid arthritis, and one of them had ankylosing spondylitis. Three of them had high BSR Risk Stratification. Most of them had used daily steroid therapy. Fatigue, abdominal pain, diarrhea, and cough were the common symptoms found.  None of the patients were admitted to ICU, used mechanical ventilators, and all of them survived. Most of the patients were prescribed anti-coagulant therapy. This first comprehensive case series can provide valuable information regarding the clinical characteristics of COVID-19 infection in the Indonesian autoimmune disorder patient population.

Giant urethral caruncle resembling urethral prolapse causing outflow obstruction.

Urethral caruncle is a rare condition primarily affecting elderly. Sometimes, it resembles urethral prolapse or malignancies. It can even cause outflow obstruction or urinary retention. A case of 83-years-old woman with urinary retention since a week prior was presented. Physical examination revealed a bulging mass originating from posterior lip of external urethral meatus. Due to the size, it caused outflow obstruction. The whole mass was excised. Histology examination reported the mass as urethral caruncle. Urethral caruncle is a common problem in elderly which rarely cause outflow obstruction. A thorough examination is required to distinguish it from malignancies and other disorders.