Insight Urology

Instructions for Authors

Phitsanu Mahawong — 2025-12-31

Editorial Board

Phitsanu Mahawong — 2025-12-31

Editorial

Phitsanu Mahawong — 2025-12-31

Factors associated with successful clean intermittent catheterization in children with neurogenic lower urinary tract dysfunction

Attawat Angsupankosol — 2025-12-31

Objective: Clean intermittent catheterization (CIC) is the standard treatment for children with neurogenic lower urinary tract dysfunction (NLUTD). Despite its effectiveness, many patients encounter obstacles such as the affordability of necessary instruments and finding a suitable location for CIC, which can impact treatment outcomes. This research aims to investigate factors associated with successful CIC in children with NLUTD.

Materials and Methods: This is an observational analytical study, focusing on patients under 18 diagnosed with NLUTD through urodynamic studies at our center from 2009 to 2020. Multivariate analyses were conducted to identify factors associated with successful CIC and prevalence of UTI in children with NLUTD.

Results: Between 2009 and 2020, 233 patients were recruited onto the study. Of these, CIC was successfully achieved in 148 (63.5%) cases. The effectiveness of performing CIC was high at 93.2%, with a cooperation rate of 94.6%. n the unsuccessful group, numbering 85, 71 patients (83.5%) experienced UTI, with the mean occurring approximately 8 months after the diagnosis of neurologic bladder dysfunction. Multivariate analysis revealed that the ability to perform CIC effectively (OR 5.679; 95%CI 2.423-13.311) is an independent factor associated with successful outcomes. However, no significant differences were found between the successful and unsuccessful CIC groups regarding cooperation, socioeconomic status, caregiver, etiology of disease, medication use, number of CIC, school environment, healthcare provider access, and gender.

Conclusion: The ability to perform CIC effectively is the primary factor associated with successful CIC in children diagnosed with NLUTD. Improving the effectiveness of CIC is crucial for the achievement of success treatment of these patients.

Overall detection rate of prostate cancer using MRI/US fusion-guided prostate biopsy in Rajavithi Hospital

Thanya Thongmalai — 2025-12-31

Objective: To study the detection rate of prostate cancer by using targeted MRI/US guided prostate biopsy in Rajavithi Hospital.

Materials and Methods: Patients with elevated PSA levels or abnormal digital rectal examinations who underwent prostate MRI with abnormal lesions (PIRADS ≥ 3) from January 2021 to October 2023 were enrolled onto the study. Patients under- went targeted MRI/US-guided biopsy, followed by a 12-core systematic transrectal ultrasound (TRUS) biopsy. The primary outcome was the overall detection rate of prostate cancer using MRI/US fusion-guided prostate biopsy. Secondary outcomes were the detection rate of prostate cancer in each PIRADS, detection of clinically significant prostate cancer in MRI/US-guided biopsy and complications.

Results: Patients 203 fulfilled the entry criteria and underwent both targeted MRI/US-guided biopsy and TRUS biopsy. The overall detection rate of prostate cancer from targeted MRI/US-guided biopsy was 32.50% which was significantly higher than detection by TRUS biopsy (25.60%, p < 0.05). In a subgroup analysis of each of PIRADS 3, 4 and 5, the detection rate was 8.8%, 40.50%, and 50.50%, respectively. MRI/US guided biopsy can more accurately detect clinically significant prostate cancer than TRUS biopsy (75.80% and 69.20%, respectively, OR1.39.95%CI 0.62-3.14, p = 0.54) with lower rates of insignificant prostate cancer (24.20% and 30.80%). However, the results did not reach statistical significance. The detection rate of prostate cancer when combining MRI/US fusion guided and TRUS biopsy was more successful than TRUS biopsy alone (38.90% vs. 25.60%, p < 0.05) or targeted MRI/US guide biopsy alone (38.90% vs. 32.50% p < 0.05). Complications included gross hematuria, fever, urinary retention and hematoma.

Conclusion: Targeted MRI/US-guided biopsy resulted in a higher detection rate of prostate cancer than systematic TRUS biopsy.

Impact of the position of the distal end of the ureteral stent and stent-related symptoms in patients with indwelling ureteric stent

Prarch Boonkerd — 2025-12-31

Objective: A ureteral stent is extensively employed to treat various urologic conditions including ureteral obstruction from external compression, stone, or post-urological procedures. Ureteral stent-related symptoms, such as lower urinary tract symptoms (LUTS), hematuria, and pain, have frequently been found in patients with indwelling ureteral stents. The impact of the position of the distal end of the ureteral stent on stent-related symptoms remains controversial.

Materials and Methods: Twenty-five patients with indwelling ureteral stents undergoing ureteral stent replacement or removal were recruited onto the study. A Thai USSQ was completed before stent replacement or removal. The position of the distal end of the ureteral stent was categorized into 2 groups by Fluoroscopic study or X-ray before stent replacement or removal. The relationship between the position of the distal ureteral stent and the USSQ score was analyzed.

Results: The mean USSQ score was 59 (range 28-112). The majority (60%) of participants had a distal ureteral stent that crossed the midline. The mean stent indwelling time was 2.18+/-1.14 months (range 0.5-4 months). The urinary tract symptoms did not differ significantly between the two groups (OR 1.05, 95%CI 0.92-1.2, p = 0.492). There were also no significant differences between the two groups with regard to the USSQ sub-scores for urinary symptoms (p = 0.509), pain (p = 0.957), general health (p = 0.443), working performance (p = 0.770), sexual symptoms (p = 0.716), and additional problems (p = 0.272). In the case of other factors, the female sex was significantly related to hematuria symptoms (IRR 1.90, 95%CI 1.09-3.73, p = 0.026). The cross-midline group also had significantly higher lower abdominal pain (p = 0.041). Patients with stents that did not cross the midline had significantly fewer symptoms of urinary tract infection (p = 0.035), but there was no significant difference in antibiotic use (p = 0.574) between the two groups.

Conclusion: The position of the distal end of the ureteral stent does not affect urinary symptoms. Discussion with the patient about stent placement, procedure, and related symptoms before and after stent placement remains crucial.

Comparison of biochemical recurrence rate and oncologic outcomes between anterior and lateral approach to laparoscopic radical prostatectomy

Wongsatorn Choowanich — 2025-12-31

Objective: Malignancy of the prostate is the fourth most common malignancy in older Thai men. At present, laparoscopic prostatectomy is one of the most common forms of treatment for prostate cancer. In Rajavithi Hospital, two different approaches are used to carry out a laparoscopic prostatectomy, the anterior approach and the lateral approach. The aim of this study was to compare the oncologic outcomes between the two approaches and to follow the biochemical recurrence rate after surgery. The pathological, oncological outcomes between an anterior approach laparoscopic prostatectomy (AA-LRP) and a lateral approach laparoscopic prostatectomy (LA-LRP) were compared with a focus on pathologic outcomes including free margin, lymphovascular invasion, and seminal vesical invasion.

Materials and Methods: A retrospective review was carried out using prospectively collected data on 230 patients who underwent AA-LRP (n = 96) and LA-LRP (n = 134) carried out by a single surgeon between January 2005 and December 2022. Pathological and biochemical recurrence were also examined.

Results: No statistical significance was found in overall oncologic outcomes between the AA-LRP and LA-LRP, positive margin between the anterior approach (32.7%) and lateral approach (42.4%) (p = 0.166). No statistically significant differences were found regarding LVI-positive and seminal vesicle-positive between the two techniques. Kaplan–Meier analysis did not show any statistically significant differences with respect to biochemical recurrence between the two approaches, specifically anterior approach (mean follow-up 108 months) no biochemical recurrence = 73.0% lateral approach (mean follow-up 78 months) no biochemical recurrence = 66.7% (p = 0.371).

Conclusion: We conclude from this data from our institute that there was no statistically significant difference in oncologic outcome and biochemical recurrence rate in this single-surgeon comparative series between AA-LRP and LA-LRP. Further prospective studies are warranted to determine whether any particular technique is superior to the other in oncologic outcomes and biochemical recurrence rate.

Evaluation of AI and radiologist contouring in prostate MRI for targeted MRI/US fusion biopsy

Danai Manorom — 2025-12-31

Objective: Prostate cancer is an increasingly prevalent public health issue, particularly in aging populations such as Thailand. While traditional diagnostic methods like systematic transrectal ultrasound-guided biopsy are widely used, they can result in overdiagnosis and unnecessary treatment. MRI/Ultrasound (MRI/US) Fusion Biopsy offers greater precision by targeting suspicious areas detected in MRI scans. However, manual contouring of the prostate and lesion locations by radiologists or urologists is time-consuming and subject to variability, potentially delaying diagnosis and treatment.

Materials and Methods: This retrospective study developed and evaluated an AI-based prostate segmentation model using 125 annotated prostate MRI cases (3,193 images) from a public dataset for training, and then it was tested on 109 clinical cases (2,952 images) from the National Cancer Institute. The model combined a YOLO-based bounding box detection with the segment anything model (SAM) for prostate segmentation. Model performance was compared to radiologist-drawn contours using dice similarity coefficient (DSC) and % relative percent difference (RPD) in prostate volume estimation.

Results: For cases not requiring post-processing, the AI model achieved a mean DSC of 0.72 and an RPD of 8.90% in comparison to radiologist contours. For cases requiring post-processing, the DSC dropped to 0.66 and the RPD increased to 13.45%. These results indicate a high level of agreement between the AI and expert annotations, particularly in standard cases.

Conclusion: The AI-based model demonstrated promising accuracy with regard to segmentation of the prostate gland on MRI scans, comparable to radiologist performance. This approach has the potential to reduce diagnostic delays and lessen the workload of radiologists in prostate cancer workflows. Future improvements should focus on enhancing model precision, incorporating prostate imaging-reporting and data system (PI-RADS) scoring, and validating the system across diverse clinical settings to support safe and effective integration into routine diagnostic practice.

Complications of ureteroscopy with intracorporeal lithotripsy in patients with urinary tract infection

Ornsinee Senkhum — 2025-12-31

Objective: To study the risk of complications associated with ureteroscopy with intracorporeal lithotripsy in patients with urinary tract infection.

Materials and Methods: 420 patients who underwent ureteroscopy with lithotripsy from March 2022 to March 2024 in Sisaket Hospital were enrolled onto this study. Data pertinent to baseline characteristics, perioperative variables, successful outcome and associated complications were collected retrospectively. The efficacy of the procedure, including complications, length of hospital stay, and pain score, was analyzed and comparisons were made between patients with and without sepsis.

Results: 89 patients were categorized as being in the sepsis group, and 331 patients in the non-sepsis group. The average age in the sepsis group was 51.2 years and patients in the non-sepsis group were slightly older at 55.56 years. 58.43% of the sepsis group had no underlying disease, and 56.19% of the non-sepsis group (p = 0.706). There was no significant difference betweentotal complications in the sepsis and non-sepsis group at 24.72% and 18.73% respectively (p = 0.221). The most common complication was post-operative fever. There were no serious complication in the sepsis group. The mean hospital stay in the sepsis group was 3.99 days, which is significantly higher than in the non-sepsis or controlgroup, which was 2.94 days (p = 0.002). The pain score in the sepsis was significantly higher than in the controls.

Conclusion: Our study demonstrated that the postoperative complications of URSL in a non-sepsis group are comparable to the sepsis group. But sepsis increased the length of hospital stay and resulted in higher postoperative pain. The definitive treatment with URSL is safe for ureteric stone in mild sepsis patients. However, further large comparative studies with adequate follow-up stone clearance are recommended to support our results.

A comparison of complications following transperineal and transrectal prostate biopsy in Rajavithi Hospital

Thanawit Ruangrat — 2025-12-31

Objective: Prostate cancer is one of the most prevalent cancers globally. While transrectal ultrasound-guided biopsy remains the gold standard, it carries several risks of complication. Recent advancements in 3D magnetic resonance imaging have improved cancer detection rates and reduced the incidence and severity of complications. Since 2021, Rajavithi Hospital has implemented this technology, yielding promising results but lacking comprehensive data regarding complications. The objective of this study is to compare the complications associated with prostate biopsy via the perineum versus the rectum and investigate the factors related to the occurrence of complications from prostate biopsy.

Materials and Methods: This retrospective study was performed using data from patients who underwent MRI fusion prostate biopsy in the Division of Urology, Department of Surgery, Rajavithi Hospital between 2021 and 2024. Data were collected from medical records, including age, digital rectal examination, PIRADS score, history of previous biopsy, biopsy core, Gleason score, prostate volume, PSA, and methods.

Results: A total of 200 patients underwent prostate biopsy, with 150 patients (75.0%) receiving the procedure via the transperineal route and 50 patients (25.0%) via the transrectal route. A total of 34 patients experienced complications: 26 in the the transperineal approach group and 8 in the transrectal approach group. A urinary tract infection (UTI) was reported in several cases after the transrectal procedure, but the findings were not statistically significant (p = 0.250). Complications such as gross hematuria, LUTS, pain, hematochezia, hematospermia, and AUR occurred variably without statistical significance.

Conclusion: This study found no significant difference in complications associated with prostate biopsy via the perineum and the rectum. The most common complication from both methods is lower urinary tract symptoms (LUTS).

Covers

Phitsanu Mahawong — 2025-12-31

MRI-PET fusion biopsy in prostate cancer at Lerdsin Hospital: two cases report

Varathorn Lumyai — 2025-12-31

MRI–PET fusion biopsy is a novel technique that enhances the accuracy of prostate lesion localization and sampling. This method potentially improves diagnostic precision when compared with conventional MRI-guided biopsy. In the two cases described here MRI–PET fusion ultrasound biopsy was utilized for prostate cancer evaluation. A 65-year-old male with a prostate-specific antigen (PSA) level of 8.0 ng/ml underwent prostate MRI, which revealed two suspicious lesions (PI-RADS 5 and PI-RADS 4). MRI–PET imaging alone identified only the PI-RADS 5 lesion (SUVmax 21.51) and an additional area of uptake in the transitional zone (SUV 6.83). Fusion biopsy confirmed adenocarcinoma Gleason score (GS) 4 + 4 and 4 + 3 in the PI-RADS 5 and 4 lesions, respectively, while the transitional zone was benign (BPH). Laparoscopic radical prostatectomy confirmed GS 4 + 4 with 10% tumor involvement. The second case involved a 75-year-old male with a PSA level of 7.53 ng/mL who underwent MRI, which demonstrated PI-RADS 5 and 3 lesions. PET imaging showed positive uptake in both (SUVmax 10.53). Fusion biopsy revealed benign prostatic hyperplasia in both lesions. In these two cases, MRI–PET fusion ultrasound biopsy enabled improved lesion detection and boundary delineation in comparison with standard MRI. Although slightly more expensive, this technique may enhance diagnostic accuracy. Further studies are warranted to evaluate its role in patients with PSA levels of 4–10 ng/ml.

Colo-renal fistula in a patient with recurrent UTI: a case report and review of the literature

Pramote Sae-oueng — 2025-12-31

Colorenal fistula is a rare and diagnostically challenging condition due to the variation of clinical presentations and diverse etiologies. This is a case report on a patient presenting with pneumaturia and recurrent urinary tract infections (UTIs). The patient had a 19-year history of multiple UTIs, including episodes of acute pyelonephritis, orchitis, and cystitis. A severe episode occurred five years earlier, when he developed a liver abscess. Computed tomography (CT) revealed air within the left renal pelvis and urinary bladder. The atrophic left kidney was adherent to the descending colon, leading to a diagnosis of colorenal fistula. The patient underwent left nephrectomy with segmental colon resection. The postoperative course was uneventful except for a wound infection on day 4, which was resolved with treatment. Histopathological examination demonstrated chronic inflammation. This case presents as a chronic colorenal fistula with a prolonged asymptomatic phase.

Robotic urologic reconstruction: preservation of open principles and expansion of possibilities

Wattanachai Ratanapornsompong — 2025-12-31

Robotic surgery has transformed the carrying out of many urological subspecialties, but its greatest potential may lie in complex reconstruction. Traditional open surgery remains the foundation for urethral and ureteral reconstruction, where tactile feedback and vascular preservation are paramount. However, robotic technology now enables these same principles to be applied with magnified precision, stable visualization, and access to planes once unreachable by hand. This review summarizes how robotic systems offer new dimensions in reconstructive urology from retroperitoneal access to fluorescence-guided dissection, and discusses their applications in ureteral, bladder neck, and gender-affirming surgeries.

Insight Urology

Instructions for Authors

Editorial Board

Editorial

Contents

Factors associated with successful clean intermittent catheterization in children with neurogenic lower urinary tract dysfunction

Overall detection rate of prostate cancer using MRI/US fusion-guided prostate biopsy in Rajavithi Hospital

Impact of the position of the distal end of the ureteral stent and stent-related symptoms in patients with indwelling ureteric stent

Comparison of biochemical recurrence rate and oncologic outcomes between anterior and lateral approach to laparoscopic radical prostatectomy

Evaluation of AI and radiologist contouring in prostate MRI for targeted MRI/US fusion biopsy

Complications of ureteroscopy with intracorporeal lithotripsy in patients with urinary tract infection

A comparison of complications following transperineal and transrectal prostate biopsy in Rajavithi Hospital

Covers

MRI-PET fusion biopsy in prostate cancer at Lerdsin Hospital: two cases report

Colo-renal fistula in a patient with recurrent UTI: a case report and review of the literature

Robotic urologic reconstruction: preservation of open principles and expansion of possibilities