Peggy Sau-Kwan Chu

The destruction of the lower urinary tract by ketamine abuse: a new syndrome?

To report the clinical spectrum seen in young abusers of street‐ketamine (regular recreational abusers of street‐ketamine, for its hallucinogenic effects) in Hong Kong, presenting with significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.

Assessing the accuracy and generalizability of the preoperative and postoperative Karakiewicz nomograms for renal cell carcinoma: Results from a multicentre European and US study

The preoperative and postoperative Karakiewicz models for RCC are considered among the best prognostic tools available for clinical counseling. Nevertheless, their predictive acuracy was externally validated only in two papers: by the same author and in an independent sample of Asian patients. However, these models have not been externally validated in truly independent multicentre series of patients. Our study demonstrated that these models 1) provide robust prognostic information; 2) were robustly built; 3) are useful also in population far from the original series. The present results are the first to show the validity and generalizability of Karakiewicz nomograms, which are based on surgical series from European centres, for large‐, mid‐ and small‐volume European and American centres.

Augmentation cystoplasty: Urodynamic and metabolic outcomes at 10-year follow-up.

To review the urodynamic outcomes, renal function and metabolic complications after augmentation cystoplasty with at least 10 years of follow‐up.

Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia

Abstract Purpose: To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care. Methods: A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing test–retest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS). Results: The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbach’s alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size = 0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively. Conclusions: The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups.

Lessons learned from Asian Urology.

Glasgow has been in the news a lot this year. The fantastic Commonwealth Games were followed by an excellent Société Internationale d’Urologie (SIU) meeting with its unique Scottish flavour. This month we move our attention to two other nations that have hosted the SIU – China and India. We present two large studies, which are well worth your reading pleasure, not just because of their sheer size but also for their messages and citability.

Hepatic haematoma after shockwave lithotripsy for renal stones

Extracorporeal shock wave lithotripsy (SWL) is a non-invasive procedure for urolithiasis. Only a very small portion of patients suffer from post-SWL haematoma and most of them have perinephric haematoma formation. We present two patients who developed subcapsular hepatic haematomas after SWL, followed by a review of the literature on the condition.

Destruction of the urinary tract by ketamine abuse: Hong Kong local experience

Aim:  To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients.

Special considerations in the urological management of the older spinal cord injury patient

PurposeThis paper reports the key findings of Committee 8 of the Joint SIU–ICUD Consultation on Urologic Management of the Spinal Cord Injured Patient and address issues pertaining to the older person with a SCI and the time-related changes relevant to their urological, gastrointestinal and functional management.MethodsA literature review using the Pubmed and Ovid search engines was performed examining pertinent literature regarding SCI in the older patient.ResultsThere is a rising incidence of both traumatic and non-traumatic spinal cord injury (SCI) in older people and improvements in healthcare and nutrition mean patients with SCI are living longer. Outcomes after a SCI in the older person are a sum of the effects of injury and its management compounded by specific effects of ageing and the emergence of unrelated comorbidities. Changes in health, comorbidities, cognition and dexterity with ageing have an impact on function and are important considerations in the management of the older patient with SCI. Treatment decisions are thus increasingly complex due to the need to take into account these changes and accompanying polypharmacy. For the person living with a SCI, changes in circumstances (social and financial) have an impact on quality of life and influence management and support strategies.ConclusionsOlder patients with SCI face additional challenges both in the acute setting and with ageing. Clinicians should take into account comorbid conditions, mental health, physical function, cognition and social support in making management decisions. With the global ageing population, health services planning will need to allow for increase in resources required to care for older patients with SCI.

A 55-Year-Old Man with Right Testicular Pain: Too Old for Torsion?

Testicular torsion is predominantly a disease of adolescence, but age itself should not be an exclusion criterion for the diagnosis. A lack of suspicion for testicular torsion in older patients may result in a missed or delayed diagnosis which jeopardizes the chance of testicular salvage. In this article, we report a case of testicular torsion in a 55-year-old Chinese man.

Cystoscopic and video-urodynamic features of a ketamine abuser

Ketamine is the most common psychotropic substance being abused by people younger than 21 years in Hong Kong since 2000. Reports had shown that ketamine abusers can present as dysuria, frequency, urgency, urge incontinence, nocturia and painful haematuria. Usually they will be diagnosed as bacterial cystitis and prescribed multiple courses of oral antibiotics with no response. However these patients had different cystoscopic and urodynamic findings with that of ordinary bacterial cystitis and we would like to present that with a case: A 21 year old female patient who had been a daily ketamine abuser for 4 years presented to us in 2007 with dysuria, painful haemturia, suprapubic pain and was diaper dependent. Her daily consumption of ketamine was 1–4 g. Numerous white and red blood cells were detected in the urine microscopy but no bacteria was cultured. Her blood creatinine level was 110 umol/L and there were bilateral hydronephrosis detected on ultrasound. Only ketamine but no other psychotropic substance was detected in the patient’s urine. Cystoscopy was performed for her under general anaesthesia and there was marked telangiectasia with erythematous mucosa. The bladder was also markedly contracted and was difficult to be distended despite that the cystoscopy was performed under general anaesthesia. Moreover there was some whitish precipitate extruding from left ureteric orifice which is suggestive of ketamine or its metabolite. (video 1) Videourodyamic study was also performed for her which revealed a poor compliance bladder with detrusor overactivity. The functional capacity of the patient was around 50 ml only. Bilateral vesicoureteric reflux up to both kidneys was also detected. (video 2) The patient was then prescribed antimuscarinic drug, scheduled for augmentation cystoplasty and was referred to the hospital authority’s substance abuse clinic for detoxification. However she died one month later for multiple injuries from falling out from height after ketamine overdose.