Keong Tatt Foo

Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume

Background: A filled bladder acts as an acoustic window for transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. The aim of this study is to evaluate the effects of bladder volume on transabdominal ultrasound measurements of these parameters.

Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of bladder outlet obstruction: Indices for bladder outlet obstruction

Aim: The aims of this study were to define the relationship between intravesical prostatic protrusion (IPP), prostate‐specific antigen (PSA) and prostate volume (PV) and to determine which one of them is the best predictor of bladder outlet obstruction (BOO) due to benign prostatic enlargement.

Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment

Objectives:  To assess intravesical prostatic protrusion (IPP) as a novel predictor of clinical progression in patients with benign prostatic enlargement (BPE).

Surgical Management of Angiomyolipoma: Nephron-sparing Surgery for Symptomatic Tumour

Angiomyolipoma (AML) is a benign renal tumour that occasionally requires intervention. We evaluated the surgical management of symptomatic angiomyolipoma, with special attention to the feasibility of nephron-sparing surgery. A retrospective study was conducted enlisting 23 patients (including 3 patients with tuberous sclerosis) who had their AML treated surgically from 1991 to 1998. The study included 7 males and 16 females, with a mean age of 49 years (range 24-75). The mean tumour size was 12.3 cm (range 1.5-30.0) including 7 lesions < or = 4 cm and 16 lesions > 4 cm. The presenting features included abdominal/loin pain (9 patients), spontaneous rupture (5 patients), non-specific symptoms (7 patients) and incidental findings (2 patients). AML was diagnosed by computed tomography in 16 patients and malignancy was suspected in 7 patients. The latter group included 5 patients with lesions smaller than 4 cm, one of them having coexisting AML and renal cell carcinoma. All patients underwent elective surgery, with the exception of one, who required a semi-emergency operation. Nephron-sparing surgery using frozen section in 5 patients (all diagnostic) was carried out on 16 patients, including all 5 patients with previous haemorrhage and 2 patients with suspected lesions from preoperative studies. Total nephrectomy was performed in 7 patients, including the other 5 patients with lesions suspected to be malignant. There was no operative mortality. Two complications were encountered in the entire group. We conclude that elective nephron-sparing surgery is feasible, even for massive angiomyolipoma or after previous rupture, especially when the diagnosis is made by preoperative imaging and/or intraoperative frozen section.

Genomic Structure of Human OKL38 Gene and Its Differential Expression in Kidney Carcinogenesis

We previously demonstrated the growth inhibitory property of OKL38 and its possible roles in mammary carcinogenesis. To further understand the regulation and roles of OKL38 in tumorigenesis we proceeded to clone and characterize the human OKL38 gene and three of its variants with transcripts of 1.9, 2.2, and 2.4 kb. The human OKL38 gene spans ∼18 kb and contains 8 exons and 7 introns with exon size ranging from 92 to 1270 bp. RT-PCR and sequence analysis suggest that different transcripts were arrived through differential promoter usage and alternate splicing. Multiple Tissue Expression array (MTE) and Multiple Tissue Northern blot (MTN) indicated that OKL38 was ubiquitously expressed in all tissues with high expression in liver, kidney, and testis. The cancer profiling array (CPA) of paired normal/tumor cDNA showed that OKL38 mRNA was down-regulated in 70% (14 of 20) of kidney tumors. Western analysis revealed that the OKL38 protein was undetectable in 78% (7 of 9 pairs) of kidney tumor tissues. Immunohistological analysis showed that 64% (14 of 22) of kidney tumors were either lost or underexpressed OKL38 protein compared with the adjacent normal tissue. A transfection study using OKL38-eGFP recombinant construct showed that overexpression of the 52 kDa OKL38 protein in A498 cells resulted in growth inhibition and cell death. This study demonstrates the complex genomic structure of the OKL38 gene and its growth inhibitory and cytotoxic properties. Our data suggest the potential use of OKL38 in diagnosis, prognosis, and/or treatment of kidney cancer.

Clinical experience and results of ESWL treatment for 3093 urinary calculi with the Storz Modulith SL 20 lithotripter at the Singapore General Hospital

We study the outcome of 2700 patients treated for 3093 urinary calculi over a period of 60 months. All patients underwent Extracorporeal Shock Wave Lithotripsy (ESWL) treatment using the Storz Modulith SL20, predominantly on an outpatient basis (99.9% using intravenous pethidine for analgesia). The treatment outcome of 1666 renal calculi and 1427 ureteric calculi were analysed and stratified according to size and site. Follow-up status at 3 months was available for 91.8% of patients. For renal calculi, the overall success rate was 81% (re-treatment rate 29.7%). The majority of failures were stones larger than 2cm and those situated in the lower pole of the renal calyces. The overall success rate for ureteric calculi is 85% with similar clearance rates throughout the ureter (re-treatment rate 22.8%). Failures were predominantly with stones larger than 2cm. For the entire series, the morbidity rate requiring hospital admission was 2.9%, there was no mortality. The commonest cause for admission was for pain control (1.8%). To our knowledge, our experience with this lithotriptor is the largest to date. We have demonstrated that ESWL with Storz Modulith SL20 is safe, well tolerated and highly effective for the treatment of urolithiasis.

Long-term follow-up of transurethral microwave thermotherapy

OBJECTIVES To evaluate the long-term results of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) with up to 5 years of follow-up at our institution. METHODS From October 1991 to November 1993, 106 patients were treated for BPH with TUMT using the Prostatron 2.0. Of the 106 patients, 64 were available for evaluation of symptoms (Madsen-Iverson score), uroflow, residual urine, and retreatment rate at a mean follow-up of 50+/-5.4 months (mean+/-SD). RESULTS The mean age of the patients was 65.2+/-9.8 years. Thirty-two patients (50.0%) were treated with one session of TUMT. Additional treatments were required for 32 patients (50.0%). Three patients had two sessions of TUMT, 14 underwent transurethral resection of prostate, and 3 had laser prostatectomy. Twelve patients received medical therapy. The mean symptom score decreased significantly from 12.9+/-2.5 to 5.7+/-3.6 (P = 0.001). The mean peak flow rates and postvoid residual volume showed little difference before and after TUMT. On the basis of the criteria described by Poincelet and Cathaud the overall clinical efficacy rate was 39.1% (15.6% complete response and 23.5% partial response). No obvious clinical parameter was useful to predict favorable outcome after TUMT. CONCLUSIONS The present study showed that the efficacy rate of TUMT with the Prostatron 2.0 at 50 months was 39.1 %. None of the preoperative clinical factors was predictive of a favorable outcome.

Solving the benign prostatic hyperplasia puzzle

Benign prostatic hyperplasia (BPH) is a common urological condition, and yet there are many puzzles waiting to be solved. This perspective is to help explain some of these puzzles, based on our recent publications and previous clinical studies on BPH.

From evidence-based medicine to evidence-balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms

In real-life clinical practice, scientific evidence alone is insufficient; experience is required to apply the scientific knowledge to the individual patient in a balanced manner, weighing the benefits and risks to the patient. For patients with benign prostatic hyperplasia (BPH)/male lower urinary tract symptoms (LUTS), there are many treatment modalities, from conservative watchful waiting to medications and surgical procedures. Each modality has its own risk and benefits. Decision-making would depend on the severity of the disease, and each individual patient’s age, comorbidity and preferences. The top priority for treating any disease is to save lives; for example, when solid organs are ruptured in trauma. In clinical BPH, sepsis with chronic obstruction can be life-threatening, though it is not common. The second priority is to preserve organ functions. The concerns in clinical BPH are the bladder functions of storage and voiding. Chronic obstruction can also lead to back pressure changes with the development of hydronephrosis, affecting kidney functions. Third, treatment is given to relieve symptoms. Whether treatment is necessary for symptomatic relief depends on the degree of bother to the patient. In this situation, the patient and not the physician is the best person to decide on the treatment, underscoring the importance of patient preferences and values in decision-making.

Benign prostatic hyperplasia and male lower urinary symptoms:A guide for family physicians

Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.