ABSTRACT
OBJECTIVES@#The objectives of this study were to compare the voiding pattern of toilet-trained patientswith and without recurrent UTI, to describe the voiding pattern of toilet-trained patients withoutUTI aged 2 to 15 years old and to describe the voiding pattern of toilet trained patients with recurrentUTI aged 2 to 15 years old.@*MATERIALS AND METHODS@#A total of 80 toilet-trained Filipino children divided into two groups with 40each were included. R-UTI group consisted of patients aged 2 to 15 years old who presented withrecurrent UTI. The control (No-UTI) group consisted of children aged 2 to 15 years old without anyurinary symptoms and without history of urinary tract infection. Parents completed a 72-hour bladderchart at home. All participants answered Farhat's DVSS. Patients underwent uroflowmetry,uroflowmetry with EMG and post void residual assessment (PVR). Qmax, uroflowmetry pattern,bladder wall thickness and PVR were recorded and analyzed using independent t-test.@*RESULTS@#The mean age of subjects with UTI was 6.32 ± 2.77 years and those in the control group havea mean age 6.67 ± 2.77 years old. Of patients of R-UTI group the following were statisticallysignificant compared to No-UTI : Constipation (48% vs 15%), mean frequency of voiding volumesgreater than 125% of the estimated bladder capacity (EBC) at daytime (0.8 ± 0.22 vs 0.05 ± 1.20p=0.0002), frequency (45% vs 5%), mean average voided volume (126.54 ± 56.05 mL vs 84.34 ±34.26 mL p=0.0001), mean daytime average voided volume (121.33 ± 59.59 mL vs 87.90 ± 36.41mL p =0.0033), mean maximum voided volume (232.25 ± 113.99 mL vs 130.85 ± 49.99 mLp<0.0001), mean bladder thickness (3.83 ± 0.68 mm vs 3.38 ± 0.62 mm p = 0.0030), mean PVR(12.96 ± 10.54 mL vs 5.21 ± 5.68 mL p=0.0001). PVR was significant in 45% of cases compared to3% significant PVR (when 4-6 years old defined as >10ml or >10%of EBC, and if >7 years old >20mlor >15% of EBC). When mean PVR was computed as percentage of EBC, R-UTI group had astatistically higher percentage compared to the no-UTI group (6.27 ± 2.52 % vs 2.52 ± 2.75 %p=0.0001). Mean observed bladder capacity (OBC) was found to be more than the EBC in 35% ofcases in the R-UTI group compared to 12% of No-UTI group (p=0.018). Uroflow-EMG in the R-UTI group were, 85% synergic, 12% dyssynergic and 3% interrupted pattern. EMG in the No-UTIgroup were, 38% synergic, 55% dyssynergic, 2% delayed relaxation, 5% interrupted. The EMGpatterns were statistically significant between the groups (p<0.0001). Uroflow patterns werecomparable between the two groups (p=1.000).@*CONCLUSION@#Constipation was more frequent in the R-UTI group. R-UTI group had a higher meanfrequency of EBC > 125% during daytime, frequency, mean average voided volume, mean averagevoided volume during daytime, mean maximum voided volume, mean bladder thickness, mean PVRcompared to the without UTI group. Mean observed bladder capacity was observed to be greater thanthe EBC in the R-UTI group compared to the No-UTI group. R-UTI group was synergic compared toNo-UTI group which were dyssynergic.
ABSTRACT
@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the diagnostic efficacy between the transperineal and the transrectal prostate needly biopsy as the initial biopsy strategy for detection of prostate cancer.<br /><strong>METHODS:</strong> A total of 179 patients with PSA of 2.5-20 ng/mL who underwent initial prostate needle biopsy were included. One hundred eight (108) patients underwent transrectal prostate needle biopsy (TRUS-BX) from March to December 2014, while 71 patients underwent transperineal prostate needle biopsy (TP-BX) from January 2015- August 2016. Descriptive statistics including mean, median and percentage were used for the patient demographics. Student's t-test was used to compare continuous variables between the two groups. X2 or Fisher's exact probability tests were used for categorical variables.<br /><strong>RESULTS:</strong> The mean age of the patients who underwent the TP-BX and TRUS-BX were 66.10 years and 62 years respectively (p=0.0003). The mean prostate volumes were 44.10 mL and 42.39 mL (p=0.5405), while the mean PSA were 9.51 ng/mL and 9.21 ng/mL (p=0.6096) for the TP-BX and TRUS-BX,respectively. The TP-BX provided a greater overall cancer detection rate of 63.38% (45/71) compared to 35.19% (38/108) obtained from the TRUS-BX (p<0.0001). Detection of clinically significant cancer, defined as Gleason score of 7 or higher was likewise greater in the TP-BX compared to the TRUS-BX (77.78% vs 55.26%; p=0.029). Among patients with PSA values of 2.5 ng/mL-10 ng/mL, cancer was detection was significantly higher in the TP-BX group (59.09% vs 31.11% p value=0.002). Cancer detection rates in patients with PSA 10ng/mL-20ng/mL were comparable in between the two groups (70.37% vs 55.56% p value =0.309). Of the patients who had cancer in the TP-BX group, 77.77%(35/45) involved in the anterior sector, 60% (27/45) the middle sector and 48.89% (22/45) the posterior sector. Thirteen out of the 35 cancers (37.14%) detected in the TP-BX group involved exclusively the anterior sector. The most common complication was hematuria at 35.21% for TP-BX and 50% for TRUS-BX. Complications that occurred exclusively for TRUS-BX included fever (2.78%) and 1 case (0.93%) of septicemia requiring hospitalization and parenteral antibiotics. Minor perienal bruising occurred exclusively in 8.45% of the patients who underwent TP-BX.<br /><strong>CONCLUSION:</strong> The transperineal prostate needle biopsy should be considered as the initial biopsy strategy for the detection of prostate cancer. The manifested advantages are the following: a) The overall cancer detection rate is significantly higher, b) The detection rate of clinically significant cancer is significantly greater, c) It provides a far more superior detection of exclusive anterior zone cancers which are often under detected or undetected with the current standard TRUS-BX and d) Complications are comparable, if not fewer than the current standard TRUS-BX.</p>