Efficacy and Safety of Gabapentin in Comparison to Solifenacin Succinate in Adult Overactive Bladder Treatment.

OBJECTIVE: To evaluate the efficacy and safety of gabapentin in comparison to solifenacin succinate and placebo for the treatment of adult patients with overactive bladder (OAB). METHOD: A 12-week, randomized, double-blind, double dummy placebo-controlled, clinical trial was conducted between October 2010 and August 2014 at a tertiary medical center. Eligible and consenting patients included were randomized into three treatment groups (placebo, gabapentin and solifenacin). After a 12-week treatment period, an intention to treat analysis was applied to assess between group differences on the micturitions and urgency episodes per 24 h; which were evaluated by 3-day micturition diary mean change from baseline to post treatment. Health related quality of life (HRQOL) domains were likewise assessed by OAB questionnaire (OAB-q). Adverse event were monitored and summarized. Study results were analyzed at statistical significance of 0.05. (ClinicalTrials.gov ID NCT01486706) RESULT: A total of 94 participants were included for end-study efficacy and safety analysis. Compared to placebo, gabapentin and solifenacin have statistically significant improvement in mean number of micturitions per 24 h (adjusted mean difference [AMD] -1.179, 95%CI -1.98, -0.38; P < 0.001; -1.706, 95%CI -2.52, -0.09; P < 0.001; respectively), and in mean number of urgency episodes per 24 h (AMD -0.903, 95%CI -1.44, -0.37; P < 0.001; -0.896, 95%CI -1.44, -0.35; P < 0.001). Gabapentin also demonstrated significant improvement over the solifenacin in the mean number of nocturia episodes/24 h (AMD -0.607, 95%CI -1.04, -0.18; P < 0.001). Adverse event related to gabapentin treatment was lesser than solifenacin, and comparable to placebo. CONCLUSION: Gabapentin treatment with acceptable safety profile, improves OAB symptoms and HRQOL domains.

Circumcision-incision orchidopexy: A novel technique for palpable, low inguinal undescended testis.

Given that both orchidopexy and circumcision are commonly done in a single operative setting, we adopted a technique of combined orchidopexy and circumcision using a single circumcision incision. We applied this new technique to boys with palpable, low inguinal cryptorchidism. Here we describe a case series of 7 boys who underwent concurrent orchidopexy via the circumcision site. We present this novel technique and discuss our preliminary outcomes, including the anatomic basis and feasibility. The technique appears to be an alternative for concurrent circumcision and cryptorchid cases with palpable, low inguinal testes.

Prevalence and factor association of premature ejaculation among adult Asian males with lower urinary tract symptoms.

PURPOSE: To determine the prevalence of premature ejaculation (PE) among adult Asian males presented with lower urinary tract symptoms (LUTS) and characterize its association with other clinical factors. METHODS: A cross-sectional study was conducted at a tertiary medical center to determine the prevalence of PE among adult male participants with LUTS during the Annual National Prostate Health Awareness Day. Basic demographic data of the participants were collected. All participants were assessed for the presence and severity of LUTS using the International Prostate Symptom Score (IPSS), and for the presence of PE using the PE diagnostic tool. Digital rectal examination was performed by urologists to obtain prostate size. LUTS was further categorized into severity, storage symptoms (frequency, urgency, and nocturia), and voiding symptoms (weak stream, intermittency, straining, and incomplete emptying) to determine their association with PE. Data were analyzed by comparing the participants with PE (PE diagnostic tool score ≥11) versus those without PE, using the independent t test for continuous data, Mann-Whitney U test for ordinal data, and Chi-square test for nominal data. The statistical significance was set at P < 0.05. RESULTS: A total of 101 male participants with a mean ± standard deviation age of 60.75 ± 10.32 years were included. Among the participants, 33% had moderate LUTS, and 7% severe LUTS. The most common LUTS was nocturia (33%). The overall prevalence of PE was 27%. There was no significant difference among participants with PE versus those without PE in terms of age, marital status, prostate size, or total IPSS score. However, significant difference between groups was noted on the level of education (Mann-Whitney U, z = -1.993, P = 0.046) where high educational status was noted among participants with PE. Likewise, participants with PE were noted to have more prominent weak stream (Mann-Whitney U, z = -2.126, P = 0.033). CONCLUSIONS: Among the participants consulted with LUTS, 27% have concomitant PE. Educational status seems to have an impact in the self-reporting of PE, which may be due to a higher awareness of participants with higher educational attainment. A significant association between PE and weak stream that was not related to prostate size suggests a neuropathologic association.

Configuration and validation of a novel prostate disease nomogram predicting prostate biopsy outcome: A prospective study correlating clinical indicators among Filipino adult males with elevated PSA level.

OBJECTIVE: To configure and validate a novel prostate disease nomogram providing prostate biopsy outcome probabilities from a prospective study correlating clinical indicators and diagnostic parameters among Filipino adult male with elevated serum total prostate specific antigen (PSA) level. METHODS: All men with an elevated serum total PSA underwent initial prostate biopsy at our institution from January 2011 to August 2014 were included. Clinical indicators, diagnostic parameters, which include PSA level and PSA-derivatives, were collected as predictive factors for biopsy outcome. Multiple logistic-regression analysis involving a backward elimination selection procedure was used to select independent predictors. A nomogram was developed to calculate the probability of the biopsy outcomes. External validation of the nomogram was performed using separate data set from another center for determination of sensitivity and specificity. A receiver-operating characteristic (ROC) curve was used to assess the accuracy in predicting differential biopsy outcome. RESULTS: Total of 552 patients was included. One hundred and ninety-one (34.6%) patients had benign prostatic hyperplasia, and 165 (29.9%) had chronic prostatitis. The remaining 196 (35.5%) patients had prostate adenocarcinoma. The significant independent variables used to predict biopsy outcome were age, family history of prostate cancer, prior antibiotic intake, PSA level, PSA-density, PSA-velocity, echogenic findings on ultrasound, and DRE status. The areas under the receiver-operating characteristic curve for prostate cancer using PSA alone and the nomogram were 0.688 and 0.804, respectively. CONCLUSION: The nomogram configured based on routinely available clinical parameters, provides high predictive accuracy with good performance characteristics in predicting the prostate biopsy outcome such as presence of prostate cancer, high Gleason prostate cancer, benign prostatic hyperplasia, and chronic prostatitis.

A study of correlation between premature ejaculation and lower urinary tract symptoms among Filipino males

OBJECTIVE: This study aimed to determine the association between Lower Urinary Tract Symptoms (LUTS) and premature ejaculation and define its prevalence and factors associated among Filipino males during the Annual National Digital Rectal Exam (DRE) day. METHODOLOGY: A descriptive cross sectional study was done in all male participants during the Annual National DRE day conducted at the Institute of Urology, St. Luke's Medical Center-Quezon City. All subjects were assessed by urologists for the presence of LUTS using the International Prostate Symptom Score (IPSS), and the Premature Ejaculation Diagnostic Tool (PEDT). The IPSS was categorized into total score (IPSS sum), storage symptoms (FUN - frequency, urgency, nocturia) and voiding symptoms (WISR - weak stream, intermittency, straining and residual urine). Ultrasound was also performed to obtain prostate size. The relationship between age, demographics, prostate size, IPSS scores, storage symptom score, voiding symptom score, and PEDT scores were analyzed using one way ANOVA. The statistical significance was set at P RESULTS: A total of 101 male participants were included in the study. Participants' age ranged from 36 to 86, with a mean age of 61 ±. The mean IPSS was 5.79 (±6.59 SD). The most common symptom is nocturia with prevalence of 32.7%. The prevalence of PE is 26.7% and 16.8% has probable PE. There are no associations between PE and age, LUTS, storage and voiding symptoms, prostate size and co-morbid illnesses such as hypertension and diabetes showing p values of 0.291, 0.226, 0.600, 0.108, 0.908, 0.954 and 0.833 respectively. However PE was associated with weak stream (P= 0.015) and educational attainment (P=0.008). CONCLUSION: Filipino men are becoming more concern about their health. LUTS are commonly seen in men in increasing age. PE is a very common male sexual dysfunction so there is a need for identification of such patients (17). Although, no correlation has been made between age, LUTS and PE in this study, however in further correlational analysis, educational status seems to have an impact in the self-reporting PE which may be due to higher awareness of participants with higher education. It is recommended that clinicians always utilize the screening questions for PE to give the appropriate treatment, since patients are often unwilling to volunteer their symptoms on PE (4.17). Our study also showed significant correlation with PE and weak stream, without association to prostate size. relating to a possible neurologic physiologic pathway rather than anatomic etiology of PE. Further study is recommended.

Five-year follow up of prostate adenocarcinoma patients treated with interstitial high dose rate brachytherapy monotherapy, a single-center experience

OBJECTIVE: Prostate cancer is the most common cancer in men and localized prostate adenocarcinoma has multiple treatment options. In this study, the objective was to review the outcome of patients that were treated with HDR brachytherapy as monotherapy in all prostate adenocarcinoma patients at the St Luke's Medical Center. MATERIALS AND METHODS: Thirty three (33) patients who underwent HDR prostate brachytherapy as monotherapy for prostate adenocarcinoma in a single institution for the past 5 years received 38 Gy in 4 fractions. The charts of these patients were reviewed to determine biochemical control using the Phoenix criteria and ASTRO definition, and toxicity. RESULTS: Patients showed good biochemical control, with 92.16% meeting the target PSA value of 2 ng/mL or less and a 96.51% without consecutive rise of PSA post brachytherapy. There was also minimal toxicity, with no report of gastrointestinal toxicity and 9.1% rate of temporary genitourinary toxicity. CONCLUSION: Good biochemical control of prostate adenocarcinoma was achieved with the use of HDR brachytherapy as monotherapy, with a minimal toxicity profile.

Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review.

BACKGROUND/PURPOSE: Gonadotropin releasing hormone(GnRH) as an adjunct to orchidopexy for the treatment of cryptorchidism is still controversial. Present evidences were studied through a meta-analysis of comparative clinical trials. METHOD: Systematic literature search was done up to September 30, 2013. Studies were independently appraised by two reviewers. Continuous data of fertility indices were extracted as weighted mean difference (WMD) and standard deviation (SD); while nominal data of fertility indices were extracted as relative risk (RR). Random effects model was used to analyze the pooled effect estimates. Inter-study heterogeneity and publication bias were assessed. PROSPERO Protocol registration (CRD42013004922). RESULTS: Ten eligible studies were included. The pooled effect estimates showed that cryptorchid children treated with GnRH when compared with controls, have significantly increased germ cell per tubule (WMD: 0.35; 95% CI 0.07-0.62, P=0.01) and increased RR to have normal value of germ cell per tubule (RR: 2.86; 95% CI 1.73-4.71, P<0.0001). Inter-study heterogeneity was noted, source identified with subgroup analysis. Publication bias was not evident. No GnRH related adverse events were reported in all studies. CONCLUSION: Evidence suggests that a subset of boys with cryptorchidism may benefit from GnRH as adjunctive to orchidopexy in improving the fertility index. However, future studies are recommended to specifically identify subgroup characteristics of cryptorchidism that will clearly benefit from the treatment.

Use of computed tomography scout film and Hounsfield unit of computed tomography scan in predicting the radio-opacity of urinary calculi in plain kidney, ureter and bladder radiographs.

OBJECTIVE: The objective of this study is to determine the diagnostic utility of computed tomography (CT)- scout film with an optimal non-contrast helical CT scan Hounsfield unit (HU) in predicting the appearance of urinary calculus in the plain kidneys, ureter, urinary bladder (KUB)-radiograph. METHODS: A prospective cross-sectional study was executed and data were collected from June 2007 to June 2012 at a tertiary hospital. The included subjects were diagnosed to have <10mm urolithiasis with non-contrast helical CT scan and KUB X-ray, which were carried out on the same day. Both KUB radiographs and CT-scout film were read by two qualified radiologists with inter-observer standardization prior to the study. Urolithiasis characteristics such as stone location, CT attenuation value, CT-scout film and KUB radiograph appearance were recorded independently by two observers. Univariate logistic analysis with receiver operating characteristic curve was generated to determine the best cut-off HU value of urolithiases not identified in CT-scout film, but determined radio-opaque in KUB X-ray. Subsequently, its sensitivity, specificity, predictive values and likelihood ratios were calculated. Statistical significance was set at P value of 0.05 or less. RESULTS: Two hundred and three valid cases were included. 73 out of 75 CT-scout film detected urolithiasis were identified on plain radiograph and determined as radio-opaque. The determined best cut off value of HU utilized for prediction of radiographic characteristics was 630HU at which urinary calculi were not seen at CT-scout film and were KUB X-ray radio-opaque. The set HU cut-off was established of ideal accuracy with an overall sensitivity of 82.2%, specificity of 96.9% and a positive predictive value of 96.5% and negative predictive value of 83.5%. CONCLUSION: Urolithiases identified on the CT-scout film were also seen as radiopaque on the KUB radiograph while those stones not visible on the CT-scout film, but above the optimal HU cut-off value of 630 are also likely to be radiopaque.

2013 Annual National Digital Rectal Exam Day: impact on prostate health awareness and disease detection.

PURPOSE: "Mag-paDRE" is a yearly prostate health public awareness program initiated by the Philippine Urological Association. This study aimed to describe the demographic and clinical data of the participants in the 2013 "Mag-paDRE" program and to identify factors that will further improve prostate health public awareness. METHODS: A descriptive cross-sectional study undertaken to collect and assess the demographic data, International Prostate Symptom Score (IPSS) and digital rectal examination findings of the participants in the "Mag-paDRE" conducted in the 10 Philippine Board of Urology (PBU) different accredited training institutions. Descriptive statistics was used to report the proportion of Filipino men aged 40 or older who presented for their first prostate health evaluation. Clinical profile were reviewed and summarized. The study protocol was registered in the Clinicaltrial.gov under Identifier NCT01886547. RESULTS: A total of 925 participants from the 10 PBU accredited training institutions were assessed. Among the 10 training institutions the large tertiary government owned medical center had the highest number of participants and target participants recruited; while the private sectors owned tertiary hospitals have the highest proportion of target participants and cases. According to the predetermined definition of this study, 614 (66%) were considered the target population for the "Mag-paDRE" program. The mean age of the target participants was 58.9±9.9. Only 360 of 614 (59%) were new case, 118 (32.7%) had severe lower urinary tract symptoms (LUTS), 223 (62%) had moderate LUTS, 19 (5.3%) were asymptomatic but with hard prostates, palpable prostate nodules or prostate tenderness. The most bothersome symptoms were incomplete bladder emptying (30.2%), and frequency (22.9%). CONCLUSIONS: Overall, the 2013 "Mag-paDRE" among the 10 training institutions was effective in promoting prostate health awareness. A need to modify the preactivity information dissemination by these institutions can be done to further increase the attendance of targeted population of the prostate health awareness program.

The relevance of serum levels of long chain omega-3 polyunsaturated fatty acids and prostate cancer risk: A meta-analysis.

OBJECTIVE: Our objective was to systematically analyze the evidence for an association between serum level long chain omega-3 polyunsaturated fatty acid (n-3 PUFA) and prostate cancer risk from human epidemiological studies. STUDY PROCEDURES: We searched biomedical literature databases up to November 2011 and included epidemiological studies with description of long chain n-3 PUFA and incidence of prostate cancer in humans. Critical appraisal was done by two independent reviewers. Data were pooled using the general variance-based method with random-effects model; effect estimates were expressed as risk ratio with 95% confidence interval (CI). Heterogeneity was assessed by Chi(2) and quantified by I(2), publication bias was also determined. RESULTS: In total, 12 studies were included. Significant negative association was noted between high serum level of n-3 PUFA doc-osapentaenoic acid (DPA) and total prostate cancer risk (RR:0.756; 95% CI 0.599, 0.955; p = 0.019). Likewise, a positive association between high blood level of fish oil contents, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and high-grade prostate tumour incidence (RR:1.381; 95% CI 1.050, 1.817; p = 0.021) was noted; however, this finding was evident only after adjustment was done on interstudy variability through the removal of a lower quality study from the pool. CONCLUSIONS: High serum levels of long chain n-3 PUFA DPA is associated with reduced total prostate cancer risk. While high blood level of EPA and DHA is possibly associated with increased high-grade prostate tumour risk.

Spontaneous fracture of indwelling polyurethane ureteral stents: A case series and review of literature.

Polyurethane, due to its low cost, high versatility and availability, it commonly used for ureteral stents. Spontaneous fracture of these stents is rare, and the most dreaded complication. We present four cases of spontaneous fracture of indwelling polyurethane ureteral stents and review the literature to identify potential factors and preventive strategies.

Terpene compound drug as medical expulsive therapy for ureterolithiasis: A meta-analysis

OBJECTIVE: To investigate the efficacy of terpene compound drug (pinene, camphene, borneol, anethole, fenchone and cineol in olive oil) in facilitating spontaneous passage of ureteral calculiMETHODS: Systematic literature search of the MEDLINE, EMBASE, OVID, Science Direct, Proquest, Google scholar, Cochrane Library databases and rference lists of related literature was done without language restriction. Trials on ureterolithiasis medical expulsive therapy (MET) that compare terpene compound drug versus placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two independent reviewers according to Cochrane Collaboration recommendations. Data from included studies were extracted for calculation of risk ratio (RR) and 95% confidence interval (CI). Effect estimates were pooled using Mantel-Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed. The PRISMA guidelines for meta-analysis reporting were followed.RESULTS: Five trials (total of 344 subjects) of adequate methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to placebo/ control group, patients treated with terpene compound drug had significantly higher ureteral calculi expulsion rate (pooled RR: 1.34; 95% CI 1.12, 1.61). Analysis of studies that compare terpene compound drug with alpha-blockers showed no significant difference (pooled RR: 0.79; 95% CI 0.59, 1.06), although significant inter-study heterogeneity was noted. Only minor gastrointestinal adverse effect was reported on terpene compound drug use.CONCLUSIONS: The results suggest that terpene compound drug as MET is effective in promoting passage of ureterolithiasis. High quality large-scale RCTs comparing alpha-blockers and terpene compound drug are warranted to make a more definitive conclusion.