Insight Urology

Covers

Phitsanu Mahawong — 2024-12-29

First implantation: preparation, setup and implantation for malleable penile prosthesis

Dechapol Buranapitaksanti — 2024-12-29

Treatment for erectile dysfunction (ED) is becoming more common in Thailand. The spectrum of treatment varies from non-invasive techniques such as medication, to counseling for invasive treatment such as injection and finally to penile prosthesis implantation. As the demand for penile implant surgery increases it is increasingly crucial to ensure thorough preparation and patient care in order to minimize the risk of harmful complications, for example device infection. This review article aims to provide guidance on various aspects of the surgical process, including pre- and intra-operative patient preparation, essential equipment and supplies, and step-by- step surgical techniques. It also offers key pointers for post-operative care. This article may be valuable for those looking to start performing penile prosthesis surgery or for those seeking to improve their current practices. Literature was reviewed from PubMed and Google scholar databases. This article provides crucial information on patient selection, pre-operative counseling, surgical setup and technique, and post-operative care for malleable penile prosthesis implantation. A penile prosthesis is an excellent option for men with refractory ED as opposed to medical treatment or with contraindications to medical management. However, this operation is still relatively uncommon in Thailand. Malleable prostheses offer advantages including being cost-effective, having a low risk of malfunction, and being easier to implant in comparison to inflatable implants. This review aims to encourage, reassure, and convince new implanters to complete all spectrums of ED treatment.

Mind the gap in kidney care: translating what we know into what we do

Valerie Luyckx — 2024-12-29

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

Phimosis in children: an unfinished story

Valeerat Swatesutipan — 2024-12-29

Phimosis is a condition in which prepuce cannot be fully retracted behind the glans of the penis, which is common in boys and can occur at any age. Physiologic phimosis is a normal condition that occurs at birth and generally resolves with age as a child grows, which may take until adolescence to be completely retracted. In most cases, external hygiene is adequate care. Whereas pathologic phimosis is a condition in which the foreskin cannot be retracted at an age when retraction normally should be possible or when a previously retractable foreskin becomes non-retractable. This type of phimosis usually occurs in older children and possible ballooning of the foreskin when voiding. It can result from lichen sclerosus, recurrent episodes of balanitis or balanoposthitis, and inappropriate retraction of the foreskin. Topical corticosteroids can loosen the tissues in non-scarred prepuce in approximately 80% of cases. Phimosis can cause complications such as obstructed voiding, urinary tract infection, paraphimosis, and penile cancer. Various classifications; Kikiros, Kayaba, and Sookpotarom, have been developed to assess the severity of phimosis, making it easier to understand and compare the condition across different patients. If a patient experiences complication from phimosis that do not resolve with topical steroids, circumcision should be considered as an option. While pediatric circumcision has been shown to offer benefits in reducing the risk of urinary tract infections, HIV, sexually transmitted diseases, and penile cancer, routine neonatal circumcision is not recommended. Newborn circumcision while controversial is a familial decision and should be based on informed consent.

Editorial Board

Phitsanu Mahawong — 2024-12-29

Editorial

Phitsanu Mahawong — 2024-12-29

East Coast Malaysia mini percutaneous nephrolithotomy series: an effective and safe approach to treat renal stones

Nirmal Raj Selvakumaran — 2024-12-29

Objective: This paper aims to determine the safety and efficacy of mini percutaneous nephrolithotomy (PCNL) by evaluating the postoperative pain score, postoperative length of hospital stay, stone free-rate, perioperative blood loss, and changes in renal function in patients with nephrolithiasis.

Materials and Methods: This retrospective cohort study involved patients who underwent mini PCNL at the Hospital Tengku Ampuan Afzan (HTAA), Pahang, Malaysia, from January 1st, 2019, until December 31st, 2023. Data are presented descriptively. Changes in haemoglobin and serum creatinine pre- and post- operative were compared using univariate analysis.

Results: The cohort included a total of 50 patients who underwent mini PCNL at our centre. Ninety two percent of the cases had radiopaque stones with a median size of 1.57cm3. The total operative time was 143.7±32.16 minutes, access being established in 90% of cases via the intracostal route. Four patients (8%) had complications (two (4%) were sepsis-related). Postoperative pain was reported as mild and tolerable, with a median length of hospital stay of 2 days. The stone-free rate was 96%, and the haemoglobin drop was less than 1 g/dl (MD=-0.57 (95% CI: -0.77, -0.37), p < 0.001) following mini PCNL. There was no significant change in serum creatinine observed

Conclusion: Our study determined that mini PCNL is a safe and efficacious treatment modality in the management of nephrolithiasis in this Malaysian cohort. The growing trend of mini PCNL in Malaysian urology reflects the advancements in surgical techniques and the commitment of healthcare professionals to provide the best possible care for the patients.

Clinical outcomes and complications of percutaneous nephrolithotomy (PCNL) in multidrug resistant (MDR) bacteriuria

Kittisak Sutibud — 2024-12-29

Objective: To evaluate the outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients with multidrug resistant (MDR) urine cultures in comparison with those with normal urine cultures.

Materials and Methods: A retrospective cohort study was completed in patients who underwent PCNL at Maharaj Nakorn Chiang Mai Hospital between January, 2019 and August, 2021. The medical record charts of patients were reviewed and divided into 2 groups: those with a preoperative positive multidrug resistant culture (MDR, n=37) and those with a negative urine culture (No MDR, n=73). The following data were collected: demographics, size of stones, intraoperative data, preoperative urine cultures and postoperative complications. Association between factors and postoperative complications after PNCL were identified using a binary logistic regression model.

Results: Sepsis complications occurred in 8.2% of the patients (No MDR, n=2, MDR, n=7). The results of the multivariate analysis demonstrated a significant association between a positive preoperative MDR urine culture and postoperative sepsis complications (odds ratio (OR) = 15.21, 95%CI 1.59-145.35, p = 0.018). Conversely, female patients exhibited a decreased risk in comparison to male patients (OR 0.03, 95%CI 0.001-0.75, p = 0.003).

Conclusion: The prevalence of positive MDR bacteriuria in patients who underwent PCNL in Maharaj Nakorn Chiang Mai Hospital was relatively high. The female gender exhibited a prophylactic effect, while a positive MDR urine culture emerged as a significant risk factor for postoperative complications associated with sepsis, even in the presence of appropriately administered preoperative prophylactic antibiotics.

Comparison of enucleation efficiency of HoLEP with the early apical release ‘En Bloc’ technique between the learning curve period and after becoming proficient in HoLEP

Chonlatee Roekmongkolwit — 2024-12-29

Objective: To compare prostate enucleation efficiency using Holmium laser (HoLEP) with the early apical release ‘En Bloc’ technique between a learning curve and experienced group and to evaluate factors required to ensure proficiency.

Materials and Methods: A retrospective analysis was conducted on 120 patients diagnosed with benign prostatic hyperplasia (BPH) who underwent En Bloc HoLEP with early apical release by a single surgeon (CL) at Thammasat University Hospital between January 2019 and December 2023. The primary outcome was a comparison of enucleation efficiency (EE). EE was calculated by dividing the weight of enucleated prostatic tissue (g) by the enucleation time (min). Secondary outcomes were hematocrit (Hct) change, one-month postoperative maximum urine flow rate (Qmax), International Prostate Symptom Score (IPSS) reduction, catheter time (CT; day), length of hospital stay (LOS; day), morcellation efficiency (ME; calculate by dividing enucleated tissue weight (grams) by the morcellation time) and post-operative stress urinary incontinence (SUI) occurrence. The 120 cases were divided into a learning curve group of 60 cases and an experienced group of 60 cases. Mean EE & ME, post-operative Hct change, IPSS reduction, Qmax, CT, LOS and post-operative SUI were compared.

Results: The median (IQR) prostate weight in the learning curve group vs the experienced group was 66 (50.5-101) g vs 69 (50-95) g. Demographic and clinical data differed significantly between groups. Mean EE was significantly different between the learning curve group vs the experienced group (0.76 g/min vs 0.92 g/min (p = 0.021), respectively) after experience of 60 cases. Mean CT and LOS were decreased in the experienced group. Mean ME improved slightly but was not statistically significant.

Conclusion: The number of cases required to become proficient at the early apical released En Bloc technique of HoLEP is 60 cases.

Surgical outcomes of Holmium laser enucleation of the prostate (HoLEP) versus bipolar transurethral enucleation of the prostate (B-TUEP) in benign prostatic hyperplasia patients

Chawawat Gosrisirikul — 2024-12-29

Objective: To evaluate the outcomes and safety of the surgical technique Holmium laser enucleation of the prostate (HoLEP) in comparison to bipolar transurethral enucleation of the prostate (B-TUEP) in patients with benign prostatic hyperplasia (BPH) for whom surgery was advised by a single surgeon.

Materials and Methods: Data was collected from 36 patients who underwent HoLEP between January 2021 and June 2022 and 36 patients who underwent B-TUEP between January 2023 and August 2024 in Rajavithi Hospital. Demographic characteristics, perioperative results, complications, and functional outcomes of surgery were compared between the two groups.

Results: There was no significant difference between the groups in terms of age, blood loss, resected tissue volume, complications and pathology. The operative time, the catheterization time and the length of stay were significantly longer in the HoLEP group. There was significant postoperative improvement in international prostate symptom score (IPSS), quality of life score (QoL), peak flow rate (Q-max), post-void residual urine volume (PVR) and prostate-specific antigen (PSA) in both groups. However, the improvement in the IPSS was significantly better in the B-TUEP group.

Conclusions: The outcomes of HoLEP and B-TUEP are comparable regarding safety and efficacy for the treatment of BPH patients. However, HoLEP required a longer operative time, catheterization time and length of stay than B-TUEP.

External validation of Stone Probability Score for screening Loei urolithiasis patients

Krit Santanapipatkul — 2024-12-29

Objective: Urolithiasis is prevalent in Thailand, particularly in Loei region. Early detection is vital for effective management. In 2022, Santanapipatkul et al. developed a Stone Probability Score for screening urolithiasis patients at Loei, however, external validation of this predictive model is necessary to ensure its reliability and applicability. The objective of this study is to externally validate the Stone Probability Score for Screening Urolithiasis Patients at Loei developed in 2022.

Materials and Methods: The external validation was conducted using cross-sectional data from urolithiasis patients at Loei Hospital between June 1, 2022, and December 31, 2023. Logistic regression analysis was employed to evaluate the performance of the predictive model with regard to discrimination, calibration, and multicollinearity.

Results: This validation study included 347 patients and an accuracy of 92.6% (95%CI 88.9-96.3) was achieved with an AUC pertinent to discrimination measurement resulting in a sensitivity of 96.9% (95%CI 94.2-98.6), a specificity of approximately 53.4 % (95%CI 39.9-66.7), positive predictive value of 91.2% (95%CI 87.5-94.1) and negative predictive value of 77.5% (95%CI 61.5-89.2). The performance of the model was found to be consistent after external validation in three models in comparison with the previous study.

Conclusion: The external validation of SPS for Screening Loei Urolithiasis Patients exhibited excellent discrimination and calibration. The overall performance of the models was validated with high accuracy. This model can be used as a screening tool to identify individuals at risk of developing urolithiasis in the Loei region.

Efficacy of Orthosiphon aristatus (Cat’s Whiskers) and an alpha-blocker for stone expulsion in patients with urinary tract calculi undergoing extra corporal shockwave lithotripsy

Peeracha Kookasamkij — 2024-12-29

Objective: To evaluate the efficacy of a herbal treatment, Orthosiphon aristatus (Cat’s Whiskers) and alpha blockers with regard to stone free and treatment success rates in patients with urinary tract calculi undergoing extra corporal shockwave lithotripsy (ESWL).

Materials and Methods: Data pertinent to 84 patients who underwent ESWL for treatment of KUB stones were prospectively analyzed. Patients were randomized into two groups: Group 1: patients received the medicinal herb Orthosiphon arista- tus post ESWL and Group 2: patients received an alpha-blocker (Doxazocin 2 mg) post ESWL. Both groups used the same medication throughout the 3-month period of the study. All patients were followed-up every 2 weeks after ESWL for 3 months with x-ray and blood tests and urine tests to evaluate results and complications.

Results: The stone free rate was 47.6% in the medical herb Orthosiphon aristatus group and 45.2% in the alpha-blocker group. Treatment success rates were 69.0% in the Orthosiphon aristatus group and 54.8% for alpha-blockers group. The differences in stone free rate and treatment success rate were not statistically significantly different (p = 0.827, 0.261) and the rate of complications in the Orthosiphon aristatus group was not statistically significantly different from the other group (p = 1.000)

Conclusion: Treatment with Orthosiphion aristatus medical expulsive therapy after ESWL give similar results of stone free rate as the group taking alpha-blockers. Both treatments are equally safe methods of medical expulsive therapy.

Phitsanu Mahawong — 2024-12-29

Instructions for Authors

Phitsanu Mahawong — 2024-12-29

Insight Urology

Covers

First implantation: preparation, setup and implantation for malleable penile prosthesis

Mind the gap in kidney care: translating what we know into what we do

Phimosis in children: an unfinished story

Editorial Board

Editorial

East Coast Malaysia mini percutaneous nephrolithotomy series: an effective and safe approach to treat renal stones

Clinical outcomes and complications of percutaneous nephrolithotomy (PCNL) in multidrug resistant (MDR) bacteriuria

Comparison of enucleation efficiency of HoLEP with the early apical release ‘En Bloc’ technique between the learning curve period and after becoming proficient in HoLEP

Surgical outcomes of Holmium laser enucleation of the prostate (HoLEP) versus bipolar transurethral enucleation of the prostate (B-TUEP) in benign prostatic hyperplasia patients

External validation of Stone Probability Score for screening Loei urolithiasis patients

Efficacy of Orthosiphon aristatus (Cat’s Whiskers) and an alpha-blocker for stone expulsion in patients with urinary tract calculi undergoing extra corporal shockwave lithotripsy

Contents

Instructions for Authors