Correlation between symptoms and urodynamic findings in Thai female patients with urinary incontinence.

OBJECTIVE: To determine the accuracy of a urinary incontinence questionnaire in the diagnosis of various types of urinary incontinence classified according to the results of multichannel urodynamic testing. MATERIAL AND METHOD: Between May 2000 and April 2004, 129 women with symptoms of urinary incontinence were interviewed using a urinary incontinence questionnaire consisting of 12 urinary symptoms questions. Various patient demographic and other descriptive data were also collected. All patients underwent multichannel urodynamic testing, and classified using the International Continence Society criteria. Descriptive data and patient symptoms were tested for statistical association with the types of urinary incontinence. Sensitivity and specificity were used to measure the accuracy of the symptoms in distinguishing between the various urodynamic conditions. RESULTS: Of the 12 questions, only three questions (two stress incontinence symptoms and one overactive bladder symptom) were significantly associated with the urodynamic diagnoses of genuine Stress Urinary Incontinence (SUI) and Detrusor Overactivity (DO). The sensitivity and specificity for distinguishing between genuine SUI and DO from other urodynamic diagnoses or between each other were relatively low. CONCLUSION: Symptoms of urinary incontinence were not sufficient to predict types of urinary incontinence. Therefore, the authors suggest that urodynamic testing is still essential in the diagnosis and management of female urinary incontinence.

Solitary pancreatic metastasis from renal cell carcinoma 14 years after nephrectomy: a case report.

We report a case of solitary pancreatic metastasis from renal cell carcinoma which occurred 12 years after radical nephrectomy. The patient had no symptom. The lesion was unrecognized until 2 years later. Distal pancreatectomy was performed and the patient was still doing well 2 years after that operation. We also review the relevant literatures about prognosis, surveillance and choice of treatments for pancreatic metastasis from renal cell carcinoma.

The efficacy and safety of oral sildenafil in Thai men with erectile dysfunction: a randomized, double-blind, placebo controlled, flexible-dose study.

OBJECTIVE: To evaluate the efficacy and safety of sildenafil citrate (Viagra) in a randomized, double-blind, placebo-controlled, flexible-dose study in Thai men with erectile dysfunction of broad-spectrum etiology and more than 6 months' duration. MATERIAL AND METHOD: 125 patients aged 26 to 77 years were randomized at 4 centers in Thailand to receive either sildenafil citrate (50 mg initially, increased if necessary up to 100 mg or decreased to 25 mg depending on efficacy and/or tolerability) (n = 63) or a matching placebo (n = 62) taken on an 'as needed' basis approximately 1 hour prior to anticipated sexual activity for a period of 12 weeks. Efficacy was assessed by the patients' responses to the 15-question International Index of Erectile Function (IIEF), to questions on the event log of sexual activity, and to the global efficacy assessment question concerning improvement in erections. RESULTS: At the conclusion of the study, both the primary efficacy variables relating to the achievement and maintenance of erections sufficient for sexual intercourse and the secondary efficacy variables, which included the 5 separate domains of sexual functioning of the IIEF, the percentage of successful attempts at sexual intercourse, and the global efficacy assessment question concerning improvement in erections, were all significantly improved statistically by sildenafil in comparison with placebo except in the sexual desire domain which showed no difference. The percentage of successful attempts at sexual intercourse in the sildenafil group was 66.16 per cent while in the placebo group it was 33.05 per cent. The percentage of global efficacy assessment was improved in the sildenafil group by 82.5 per cent compared to 36.1 per cent in the placebo group. Adverse events considered treatment-related occurred in 19 patients (30.2%) receiving sildenafil and 7 (11.3%) receiving placebo. The most common adverse events with sildenafil were vasodilatation (flushing), headache, and dizziness, which occurred in 14.3 per cent, 6.3 per cent, and 6.3 per cent of patients respectively. All events were mild in nature. CONCLUSIONS: Sildenafil is a safe and effective treatment for erectile dysfunction of broad-spectrum etiology in Thai men. Its efficacy appears similar to that reported in other studies in Western populations.

Ureteral calculi during pregnancy: review of the management at Ramathibodi Hospital.

OBJECTIVE: To review our experiences with diagnosis and management of symptomatic ureteral calculi complicating pregnancy. MATERIAL AND METHOD: Medical records of all pregnant patients documented with symptomatic ureteral calculi treated at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital from 1990 to 2000 were reviewed. Presenting symptoms, diagnostic studies and management of ureteral stone were evaluated. RESULTS: Twenty patients were found in this study with the mean age of 27.5 years (18-36). The mean gestational age at presentation was 18.5 weeks (12-33). Severe flank pain was the common presenting symptom (100%), 60 per cent were on the right side and 40 per cent were on the left side, 20 per cent had associated fever and 20 per cent had irritative voiding symptoms. All of the cases had micro or macroscopic hematuria. Ultrasonography was the initial test confirming the diagnosis and visualized stones were obtained in 60 per cent of the cases. Plain KUB film was done in 6 cases and stones could be seen in 5 cases (83%). Limited IVP was done in 3 cases and the diagnosis could be done in all of them (100%). Spontaneous passing of stones was noted in 14 cases (70%) and double J stents were placed in 6 cases. Ureterolithotomy was done in 2 cases and percutaneous nephrostomy with subsequent definite stone treatment in the post partum period was done in 2 cases. No abortion and no congenital anomalies of the infant were noted. Four cases had premature labor but there was no correlation with the procedures performed for treating the ureteral stone. CONCLUSION: This study provides evidence for effectiveness of diagnosis and treatment of ureteral stone during pregnancy. The appropriate management may be helpful to reduce morbidity of urinary calculi during pregnancy.

Vesicourethral strictures after radical prostatectomy: review of treatment and outcome.

OBJECTIVE: Stricture of the vesicourethral anastomosis is a complication after radical prostatectomy. Urethral dilatation, internal urethrotomy, transurethral resection or laser therapy have been reported as the treatment for this complication. The objective of this study was to present our experience with the management of the vesicourethral stricture. MATERIAL AND METHOD: A retrospective study of 90 patients undergoing radical prostatectomy for localized prostatic carcinoma was done. The vesicourethral stricture was treated by dilatation, internal urethrotomy, and transurethral resection of scar tissue in all of the patients. Dilatation was done in less severe cases, internal urethrotomy was done in partial obliteration or after failure of dilatation. Transurethral resection was done in cases with long scar tissue. RESULTS: Ten patients (11%) had anastomotic stricture. The strictures were treated by dilatation in 5 cases, internal urethrotomy in 4 cases and transurethral resection in 1 case. Cure was achieved in all of the patients without incontinence. The median follow-up was 10 months (4-36 months) CONCLUSION: The dilatation and endoscopic procedures of the vesicourethral stricture showed a high cure rate and low incidence of incontinence.