Efficacy and safety of oral pharmacological and supplementary therapies in bladder pain syndrome: a systematic review

Treatment goals in bladder pain syndrome (BPS) or interstitial cystitis (IC) focusing on relieving symptoms to improve quality of life and avoiding adverse events (AEs) since curative treatment for BPS/IC is not available. The readily available pharmacologic options for BPS/IC including oral, intravesical, and transdermal therapy. The purpose of this study is to review randomized trial studies over the last 15 years examining the efficacy and safety of oral pharmacological and supplementary therapies for BPS/IC. A systematic search was conducted in PubMed and Medline Library. Only randomized-controlled trials and randomized comparative trials published between 2005 and 2020 on the efficacy and safety of oral therapies for BPS/IC were included. The keywords used were “bladder pain syndrome”, or “interstitial cystitis”, and “random” or “trial”. From 629 articles, nine were included in this review. Oral therapies included consist of cyclosporine A (CyA), amitriptyline, amitriptyline plus alpha lipoic acid (ALA) and omega-3 fatty acids (n-3 PUFA), PD-0299685, sildenafil, pentosan polysulfate sodium (PPS), AQX-1125, and hydrogen-rich water. Among retrieved trials, amitriptyline in combination with ALA and n-3 PUFA, sildenafil, and cyclosporine A proved their efficacy for BPS/IC. Sildenafil was generally well tolerated, while amitriptyline and CyA must be used with caution, the supplementation of ALA/n-3 PUFAs possibly lower dosage of amitriptyline, subsequently reduce its AEs. CyA was superior to PPS but possessed greater AEs. Further studies focusing on etiopathology and phenotype differentiation of this syndrome will greatly contribute to the development of effective therapy.

Meta-Analysis of Laparoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy as a Treatment of Large Kidney Stones

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Vaginal calculus in adult woman: A case report

Vaginal calculus in adult woman is an extremely rare condition. The diagnosis and management can be challenging due to rare cases. We present a case of vaginal calculus in adult woman secondary to urethrovaginal fistula due to previous pelvic trauma. The patient barely has no complaint until one day she is experiencing infertility. Stone extraction, vaginoplasty and urethroplasty with Martius flap were performed with satisfactory results.

Management of bladder exstrophy in an adolescent girl: a case report

Bladder exstrophy (BE) is a very rare congenital abnormality, especially in girls. We reported a 17-year-old girl with protruded bladder and urinary incontinence. Her vaginal orifice appeared stenotic and shifted anteriorly. She had an incomplete labia minora, short perineum, and anterior displacement of the anus. The pelvic radiography showed a pubic diastasis with a manta ray sign, and the ultrasonography examination showed a bicornuate uterus. She had undergone a functional reconstruction surgery with cystectomy, ileal conduit, appendectomy, and vaginoplasty along with the advancement of abdominal flap reconstruction with multiple Z-plasty. Functionally, she was able to urinate through the ileal conduit comfortably, had a regular menstrual cycle with minimal pain, had a wider vaginal canal, and had a smooth blood flow. Aesthetically, she had a good lower abdomen appearance, remained dry, and had an odorless urine. In clinical practice, this rare case report can provide additional knowledge and management of the same cases with effective results.

A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis

BACKGROUND

Erectile dysfunction (ED) is one of the sexual dysfunctions that are often encountered as a complication of male patients with stage 5 chronic kidney disease (stage 5 CKD). ED can be caused by psychological factors in patients with regular dialysis therapy. Currently, Hemodialysis (HD) therapy is the first choice in dialysis therapy and only 2% of stage 5 CKD patients are using Continuous Ambulatory Peritoneal Dialysis (CAPD) as a dialysis therapy. ED in stage 5 CKD patients should become a part of the treatment of patients with dialysis, which hopefully will improve the quality of life of patients. This study aims to compare the improvement in ED degree in patients with HD and CAPD.

METHOD

This study is an observational analytic comparative study involving 44 male patients with stage 5 CKD; 22 of whom underwent HD and the remaining 22 patients underwent CAPD. The differences evaluated were changes in the ED degree before and after dialysis, which were assessed using the International Index of Erectile Function-5 (IIEF-5).

RESULT

There were significant differences in the improvement in ED degree and IIEF-5 scores in CAPD group. In the HD group, no significant difference was obtained in the improvement in ED degree and IIEF-5 score. A significant difference was obtained in the improvement in ED degree between the HD and CAPD groups by comparing the improvement in IIEF-5 score.

CONCLUSION

Patients with CAPD have a better improvement in ED degree than patients with HD. Duarsa GWK, Kandarini Y, Winarta GK, et al. A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis. J Sex Med Rev 2021;18:920-925.

Sexual Dysfunction Reduction in Female Patients with Chronic Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis

BACKGROUND

chronic kidney disease (CKD) is a major worldwide health problem. One key treatment for end-stage CKD patients is dialysis therapy such as Continuous Ambulatory Peritoneal Dialysis (CAPD). This study aimed to find out the differences in the incidence of sexual dysfunction in women with CKD by CAPD.

METHODS

this study was a multicenter observational analytic study design in female samples before CAPD and after CAPD. It was conducted between November 2018 - January 2019 with 26 female respondents. They were assessed using the Female Sexual Function Index (FSFI) questionnaire at pre-CAPD and post-CAPD.

RESULTS

the results of the FSFI score before CAPD were 32.77 (SD 19.72) and after CAPD was 48.88 (SD 20.29). Analysis of differences in FSFI scores before and after CAPD demonstrates that there was a significant difference (p = 0.003).

CONCLUSION

women with CKD who underwent CAPD, had an increase in FSFI scores compared to before CAPD. Thus, the use of CAPD can be seen to reduce sexual dysfunction and therefore improve the quality of life of women with CKD.

Predictor of Successful DJ Stent Insertion in Advanced Cervical Cancer

BACKGROUND: Metastatic cervical cancer in the ureter may lead to obstructive uropathy due to mechanical ureteral blockage. The insertion of a double J (DJ) stent is a urinary diversion option that can be offered to the patients, but it becomes challenging due to the high rate of failures. AIM: The aim of the study was to determine the factors that predict the success of DJ stent insertion in obstructive uropathy due to advanced cervical cancer. MATERIALS AND METHODS: The patients studied were those with obstructive uropathy due to advanced cervical cancer from 2017 to 2020 in Sanglah General Hospital. The research subjects were divided into two groups: First were the samples of successful DJ stent insertions and the second were those that failed. In the analysis, the Chi-square tests were used for categorical data, while the independent t-tests were used for normally distributed data. Logistic regression analyses which involved both the univariate and multivariate were conducted to determine the factors that aided the success of DJ stent insertions. RESULTS: Retrograde stent insertion of DJ stents was conducted on 100 patients. Successful insertions were found in 57 patients (57%), while those that failed were observed in 43 subjects (43%). The results of multivariate regression analyses showed that low-grade hydronephrosis (odd ratios [OR] = 62.024; p = 0.000; confidence interval [CI] = 9.485–405.596), normal albumin levels (OR = 5.856; p = 0.018; CI = 1.359–25.243), lower Federation of Gynecology and Obstetrics (FIGO) staging (OR = 14.985; p = 0.007; CI = 2.108–106.536), and a history of radiotherapy (OR = 8.758; p = 0.005; CI = 1.943–39.477) were the significant factors for predicting the success of DJ stent insertions. CONCLUSION: Low-grade hydronephrosis, normal albumin levels, lower FIGO staging, and a history of radiotherapy are the strong factors for predicting the success of DJ stent insertions in obstructive uropathy due to advanced cervical cancer.

Flap Method is Better Than the Tubularized Incised Plate Method for the Surgical Treatment of Distal Hypospadias

BACKGROUND: Urethroplasty techniques generally can be divided into two methods, the flap method (Mathieu and Onlay Flap) and no flap with tubularized incised plate (TIP) urethroplasty method. Complications are common after urethral reconstructioninclude urethrocutaneous fistulae and cosmetic appearance, which is usually measured by Hypospadias Objective Penile Evaluation (HOPE) scoring system. AIM: The aim of this study was to determine whether there are differences in the outcome of flap method compare to TIP method in distal hypospadias patients who underwent urethroplasty. PATIENTS AND METHOD: The subjects of this study were patients with distal hypospadias who underwent urethroplasty in Sanglah General Hospital from September 2017 to December 2017. Thirty-six samples were selected by consecutive sampling. RESULTS: The results showed a significant difference in the incidence of meatal stenosis (p = 0.05) and urinary stream disturbances(p = 0.05) between two methods. No significant differences were found in the incidence of urethrocutaneous fistulae (p = 0.500) and the unsatisfactory HOPE score (p = 0.169). CONCLUSION: This research showed that meatal stenosis andthe maximum urinary stream were better in flap method compared to TIP method in distal hypospadias patients underwent urethroplasty.

Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients

Objective

Benign prostatic hyperplasia (BPH) is one of the most common diseases found among elderly men. Even though multiple risk factors of BPH have been identified in the past, the risk factors which have a direct impact on prostate volume have not been identified. In this study, we aim to determine the most significant contributing risk factors to prostate volume enlargement by analyzing possible associated risk factors previously studied.

Methods

This is a quantitative study with an analytical observational design, performed using a retrospective cohort approach. Total sampling was performed on 83 patients who underwent transurethral resection of the prostate (TURP) in Sanglah General Hospital from January to February 2019. Bivariate analysis is performed to examine each variable's association with prostate volume followed by a multivariate analysis. All variables were reassessed with path analysis to measure the direct effects, indirect effects, and total effects on prostate volume.

Results

Bivariate analysis shows that serum testosterone (R=0.208; p=0.059) and prostate-specific antigen (PSA) level (R=0.626; p=0.001) have a significant association with prostate volume. Multivariate analysis shows that serum PSA (B=1.4; p=0.001; 95% confidence interval [95% CI]=1.039–1.770) and testosterone (B=0.024; p=0.005; 95% CI=0.008–0.041) levels are significant among all the analyzed risk factors. There is a significant and strong effect of PSA to prostate volume (c=0.636; p=0.001) whereas testosterone has a significant albeit weak effect to prostate volume (c=0.246; p=0.009) based on the total effect of the path analysis.

Conclusion

Serum testosterone and PSA levels are significantly associated with prostatic volume increase among BPH patients.

Risk Factors for Prostate Volume Progression After Prostate-Transurethral Resection

Background

Many factors could contribute to the cases of residual benign prostate hypertrophy (BPH) volume after transurethral resection of the prostate (TURP), such as age, obesity, testosterone level, and inflammation. The goal of this study was to determine the risk of tumor necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β) in prostate tissue, serum prostate-specific antigen (PSA), serum testosterone, and age in promoting prostate volume progression after TURP.

Patients and Methods

This was a prospective cohort study on 83 BPH patients who underwent TURP at five hospitals in Bali, Indonesia. Trans-rectal ultrasonography (TRUS) was carried out to examine the prostate’s size. Three years after, we redo the TRUS examination to collect the data of the latest prostate size. TNF-α, TGF-β, serum PSA, testosterone, and age were registered for analysis. We used Pearson’s and Spearman’s correlation tests and multivariate analytic linear regression test (coefficient β) by SPSS 13.0 software.

Results

Age, testosterone, PSA, TNF-α, TGF-β were positively correlated to prostate’s volume progression. The prostate volume was strongly correlated with age (r= 0.749, p <0.001), PSA level (r=0.896, p <0.001), testosterone level (r=0.818, p <0.001), and TGF-β (r=0.609, p <0.001). The TNF-α level has a weak correlation to prostate’s volume progression (r=0.392, p <0.001).

Conclusion

TNF-α, TGF-β, PSA, testosterone, and age were significant as the risk factors in promoting the prostate volume progression after TURP.

An unusual case of lymphadenopathy due to Continuous Ambulatory Peritoneal Dialysis becomes a challenge during renal transplantation

A 31-year-old male was diagnosed with Stage V Chronic Kidney Disease and treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) for five years before agreeing to a renal transplantation. Prior to the procedure he suffered from lymphadenopathy due to peritonitis. This complication became an obstacle as it prevented vascular access to the iliac artery and vein. An extensive lymphadenectomy had to be performed before continuing with the procedure. Nevertheless, the procedure was carried out successfully. Iliac lymphadenopathy as a result of peritonitis due to CAPD could become a challenge during renal transplantation if it hindered vascular access during anastomosis.

Functional and Cosmetic Urethroplasty Outcome, Emotional Stress after Genital Examination, Post Traumatic Stress Disorder, and Ages at the Time of Urethroplasty as Potential Risk Factor Causing Psychosocial Disorder of Hypospadia Children

BACKGROUND

Children with hypospadias, being born with congenital abnormalities, having repeated genital examination, hospitalization, and undewent genital surgery, experienced psychological stress that may negatively affect their psychosocial life. Choosing the proper time of surgery as recommended is important, since it may have a positive impact on the psychosocial adaptation.

AIM

This study aims to find the risk factors causing psychosocial disorders in post-repair surgery on hypospadias children.

METHODS

This is a case control study, from 203 hypospadias patients underwent urethroplasty from 2009 to 2018. Subjets were screened for psychosocial disorders by Pediatric Symptoms Questionnaire 17 (PSC-17) questionnaire to find those with psychosocial disorders, score 15 or more (case group) and those without psychosocial disorders (control group), score 0-14. We traced back the data retrospectively from both group (history of utrethrocutaneous fistula and meatal stenosis, age upon urethroplasty) and collecting new ones (cosmetic outcome, emotional stress after genital examination, and the existence of PTSD). Fisher's exact test was performed to see the Odds ratio (OR) for each variable.

RESULTS

Some children with hypospadias show impaired on psychocosial. Functional and cosmetic outcome not significantly different as potensial risk factor psychosocial disorders, genital examination doesn't trigger psychological stress and also none children show PTSD symtomp after surgery. Comparison time of age urethroplasty did not differ significantly between two group.

CONCLUSIONS

Twenty-nine children post urthroplasty show psychosocial disorders. Functional and cosmetic urethroplasty outcomes, emotional stress after genital examination, post-traumatic stress disorder were not risk factors of pshycosocial disorder of hypospadias patients. Ages at time of surgery did not differ significantly between two group and this is contradict to the previous recommendations.

Predictor factor of inguinal lymph lode metastasis in men with penile cancer at Sanglah General Hospital, Denpasar, Bali

Background: To know predictor factors of inguinal node metastasis in penile cancer. Methods: A retrospective study about penile cancer in Sanglah Hospital, Bali, from 2011 to 2015. Patients had undergone partial or total penectomy, and inguinal node dissection or excisional biopsy for histopathology finding. Results: A 65 penile cancer patients were diagnosed for 5 years. Mean age was 53,24 ± 13,42 years. Fifteen were excluded and 25 of 50 patients (50%) had inguinal node metastasis. There were significant correlation between pathologic stage (p=0,021), histologic grade (p=0,020) and vascular invasion (p=0,008) with the presence of inguinal node metastasis. Primary tumor of pT1 showed 14% inguinal node metastasis compared to pT2 (42%), pT3 (67%), and pT4 (100%). Histologic grade I, had 22% inguinal node metastasis compared to grade II (50%), and grade III (100%). Only 39% patients without vascular invasion had inguinal node metastasis compared to 83% with vascular invasion. Conclusion: Pathologic stage of primary tumor, histologic grade and vascular invasion were predictor factors of inguinal node metastasis in penile cancer.

Association between Early Resistive Index Measurement and Early Graft Function and Long-Term Graft Survival after Kidney Transplantation: an Evidence-based Clinical Review

BACKGROUND

resistive index (RI) is highly utilised to assess the graft function using Doppler ultrasonography. The RI has been shown as the best ultrasound parameter to assess kidney allograft dysfunction. Several studies have established the role of the RI as a predictor of transplant failure. However, these studies were using RI measurement in the later stages post transplantation. The present study has conducted to identify the association between early RI measurement and early graft function represented as delayed graft function (DGF) and immediate graft function (IGF), as well as long-term graft survival.

METHODS

an evidence-based clinical review of studies published before May 2018 was conducted from Medline, Science Direct, EMBASE and Cochrane databases. Studies on early measurement of RI whereby the primary or secondary goals of the study related to graft function and/or graft survival were included. Studies using late RI measurement and without RI value groups were excluded. The Mantzel-Haenzel method was used to analyse pooled risk ratio and 95% confidence interval, while the heterogeneity of the study was calculated through I2 value. Data analysis was performed using Review Manager 5.3.

RESULTS

nine studies with a total of 1802 patients who had undergone a kidney transplant were analysed. DGF was found in 19% (193/1015) of the low RI group and in 42.8% (337/787) of the high RI group (RR 2.04 (95% CI 1.72 - 2.41), p < 0.00001, I2 = 28%). IGF was found in 39.5% (62/157) of the low RI group and in 10.5% (28/268) of the high RI group (RR 0.26 (95% CI 0.17 - 0.40), p < 0.00001, I2 = 0%). Long-term graft survival, with follow up between 60-144 months, was found in 83% (701/845) of the low RI group and in 69.4% (395/569) of the high RI group (RR 0.82 (95% CI 0.72 - 0.93), p = 0.002, I2 = 63%).

CONCLUSION

the results of this study emphasise the association between early measurement of RI and early graft function, and long-term graft survival. An elevated RI provides the chance of recognizing the patients with poor long-term prognosis, from the first moment after kidney transplant.

Dorsal Vaginal Graft Urethroplasty as a Treatment for Female Urethral Stricture: Case Reports of Four Patients

Female urethral stricture is uncommon and difficult to diagnose. Currently, only a small amount of literature has reported the successful treatment of female urethral stricture using a reconstruction approach. In this study we describe our results with the management of female urethral stricture using a dorsal vaginal graft. Four patients were diagnosed with female urethral stricture and were treated with urethral reconstruction using a dorsal vaginal graft. Primary urethroplasty using dorsal vaginal graft can be considered as a first-line option in the management of female urethral stricture, especially in centers with experience in graft-based reconstruction.