Correlation of Visual Prostate Symptom Score with International Prostate Symptom Score and Uroflowmetry Parameters in Nepalese Male Patients with Lower Urinary Tract Symptoms.

INTRODUCTION: International prostate symptom score is a validated questionnaire used to evaluate the lower urinary tract symptoms in benign prostatic hyperplasia. Visual prostate symptom score is a new simplified symptom score with pictograms to evaluate the same. We evaluated the correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms. METHODS: Male patients aged ≥40 years attending the Urology clinic were enrolled in the study. They were given international prostate symptom score and visual prostate symptom score questionnaires to complete providing assistance whenever needed. Demographic data, examination findings and uroflowmetry parameters were noted. Correlation and regression analysis was used to identify correlation of the two scoring systems and uroflowmetry parameters. RESULTS: Among the 66 patients enrolled, only 10 (15.15%) patients were able to understand English language. There was a statistically significant correlation between total visual prostate symptom score and international prostate symptom score (r= 0.822; P<0.01). The correlations between individual scores of the two scoring systems related to force of urinary stream, frequency, nocturia and quality of life were also statistically significant. There was also a statistically significant correlation of both scores with maximum flow rate and average flow rate. CONCLUSIONS: There is a statistically significant correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters. IPSS can be replaced with simple VPSS in evaluation of lower urinary tract symptoms in elderly male patients.

Cystoscopic bladder biopsies: a histopathological study.

Urothelial carcinoma is the most common tumor of the bladder and is a major cause of morbidity and mortality. Cystitis constitutes an important source of clinical signs and symptoms. In this study 31 cystoscopic biopsies subjected for histopathological examination were taken. The study was conducted in the department of Pathology of Nepal Medial College Teaching Hospital over a period of two years (October 2012 to September 2014). The mean age of the patient undergoing cystoscopic biopsy was 61.3 years, most of the patients being elderly male. 51.6% cases were clinically malignant. The most common histopathological diagnoses were cystitis (29%) and non invasive papillary urothelial carcinoma, low grade (29%). 58% are neoplastic lesions. 51.6% of the case was malignant lesions on histopathology. Among the malignant lesion of urinary bladder 93.7% were urothelial tumor and 6.3% were glandular neoplasm (adenocarcinoma, signet ring cell). There was no detrusor muscle in 33.3% cases of urothelial tumor to assess the muscle invasion. 26.7% cases of urothelial tumor shows muscle invasion. Histopathological study of cystoscopic biopsy helps in early detection of tumor and its management.

Pain during rigid cystoscopy: a prospective randomized controlled study comparing the benefit of cooled and room temperature lignocaine gel.

Lignocaine gel is an established topical anesthetic agent for cystoscopy in awake patients. We performed a prospective randomized study to evaluate whether cooling the lignocaine gel to 4 degrees C decreases the pain perception during cystoscopy in male patients. Sixty consecutive male patients undergoing rigid cystoscopy were randomized into two groups. Group I received 15 ml of 2% lignocaine hydrochloride gel at 4 degrees C and group II received the same agent at room temperature (20 degrees C). Cystoscopy was performed and pain perceived during the procedure was assessed by independent evaluator using Wong-Baker FACES pain scale rating chart. The mean pain score in group I was lower (4.32 +/- 1.70) than that in group II (5.28 +/- 1.99), but this difference was statistically not significant (p=0.191). However significantly greater percentage (84% Vs 52%) of patients with cooled lignocaine wished to have same anesthetic in future for similar procedure (p=0.032). In conclusion, cooling the lignocaine gel to 4 degrees C does not decrease the pain perception during rigid cystoscopy in male patients.

Factors predicting the success of a trial without catheter in acute urinary retention secondary to benign prostatic hyperplasia.

Trial without catheter (TWOC) is a common practice in acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) although it is not successful in all patients. We conducted this study to identify the factors predicting the success or failure of TWOC in this subset of patients. Sixty-four patients with first episode of AUR secondary to BPH were enrolled in this study. These patients were given tamsulosin 0.4 mg daily for 3 days and TWOC was performed. Baseline international prostate symptom score (IPSS), residual volume of urine drained after catheterization (RU), prostate size (PS) and intravesical prostatic protrusion (IPP) by transabdominal ultrasound were recorded. TWOC was successful in 28 (43.75%) and failed in 36 (56.25%) patients. Discriminant analysis was done to evaluate the predictive factors. IPP, IPSS, PS and RU were found to predict the outcome of TWOC. A prediction model, using cut off values, was derived using receiver operating characteristic curves (ROC). A cut-off value of 8 mm for IPP detected failures with specificity of 89% and success with a sensitivity of 92% with area under ROC (AUROC) of 0.98. Similarly cut-off values of 16 for IPSS (specificity 84%, sensitivity 81%, AUROC = 0.90), 40 gm for PS (specificity 73%, sensitivity 84%, AUROC = 0.89); and 800 ml for RU (specificity 82%, sensitivity 64%, AUROC = 0.81) were derived. IPP, baseline IPSS, PS and RU can predict the outcome of TWOC. Among these factors, IPP is the most accurate in predicting the success of TWOC.

Role of systemic anticoagulation in patients undergoing vascular access surgery.

The role of per-operative systemic heparin to improve primary patency rate of vascular access surgery is controversial. The aim of this study was to assess the risk and benefit of systemic heparin during creation of vascular access for hemodialysis in patients with chronic renal failure. Patients undergoing creation of side to end radio-cephalic arteriovenous fistula over distal forearm for hemodialysis were prospectively randomized into two groups. First group received 5000 IU of intravenous heparin during surgery whereas second group did not receive any anticoagulation. Post-operative complications and outcome of surgery were compared between the two groups. Among 50 patients, 25 received heparin and 25 did not. Although there was no significant difference in operative times between these two groups (p = 0.24), early post-operative bleeding complication was more common in patients receiving heparin (p < 0.01). The primary 6-week patency was 96.0% for patients receiving heparin and 92.0% for those not (p = 0.46). Thus per-operative systemic anticoagulation during vascular access surgery is associated with increased incidence of bleeding complication and offers no benefit in terms of primary patency

Control of pain during transrectal ultrasound-guided prostate biopsy: a prospective study comparing two methods.

AIM: To evaluate the efficacy of intramuscular injection of 75 mg diclofenac sodium and periprostatic nerve block (PPNB) with 1% lignocaine in controlling pain during transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS: A total of 120 patients undergoing TRUS-guided prostate biopsies were prospectively enrolled in the study. First, 20 patients did not get any form of analgesia/anesthesia and served as control; next, 20 patients received an intramuscular injection of diclofenac sodium. PPNB with 1% lignocaine was performed in the remaining 80 patients. Pain was assessed using Wong-Baker Faces Pain-Rating Scale (0-10). RESULTS: All three groups of patients were comparable at baseline in terms of age, prostate-specific antigen and final histological diagnosis. The mean pain scores (+/-SD) for control, diclofenac and PPNB groups were 5.10 +/- 3.14, 3.70 +/- 2.36 and 2.24 +/- 1.63, respectively. The difference was statistically significant between control and PPNB (p = 0.001), and diclofenac and PPNB (p = 0.002), but not between the control and diclofenac group (p = 0.120). In addition, the proportion of patients having mild or no pain (defined as pain score