Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country.

There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.

Comparing CxBladder to Urine Cytology as Adjunct to Cystoscopy in Surveillance of Non-muscle Invasive Bladder Cancer-A Pilot Study.

Purpose: Guidelines advocate cystoscopy surveillance (CS) for non-muscle invasive bladder cancer (NMIBC) post-resection. However, cystoscopy is operator dependent and may miss upper tract lesions or carcinoma in-situ (CIS). Urine cytology is a common adjunct but lacks sensitivity and specificity in detecting recurrence. A new mRNA biomarker (CxBladder) was compared with urine cytology as an adjunct to cystoscopy in detecting a positive cystoscopy findings during surveillance cystoscopy in our center. Materials and Methods: Consented patients older than 18, undergoing CS for NMIBC, provide paired urine samples for cytology and CxBladder test. Patients with positive cystoscopy findings would undergo re-Trans Urethral Resection of Bladder Tumor (TURBT). Results: Thirty-five patients were enrolled from April to June 2019. Seven contaminated urine samples were excluded. The remaining cohort of 23 (82%) and 5 (18%) females had a mean age of 66.69 (36-89). Eight (29%) patients with positive cystoscopy finding underwent TURBT. All 8 patients also had positive CxBladder result. This shows that CxBladder has a sensitivity and negative predictive value (NPV) of 100%, specificity of 75% and positive predictive value (PPV) of 62% in predicting a positive cystoscopy finding. TURBT Histo-pathological findings showed Low-grade Ta NMIBC in one patient (4%), and 7 (25%) patients had inflammatory changes. Urine cytology was only positive in one patient with a positive cystoscopy finding. This led to a sensitivity of merely 13% and NPV of 74%, while specificity and PPV was 100% in predicting a positive cystoscopy finding. Conclusion: CxBladder had high NPV and sensitivity which accurately predicted suspicious cystoscopy findings leading to further investigation. It has great potential for use as adjunct to cystoscopy for surveillance of NMIBC.

Oral ketamine induced pathological changes of the urinary tract in a rat model.

INTRODUCTION: In recent years, prolonged ketamine abuse has been reported to cause urinary tract damage. However, there is little information on the pathological effects of ketamine from oral administration. We aimed to study the effects of oral ketamine on the urinary tract and the reversibility of these changes after cessation of ketamine intake. METHODS: Rats were fed with illicit (a concoction of street ketamine) ketamine in doses of 100 (N=12), or 300 mg/kg (N=12) for four weeks. Half of the rats were sacrificed after the 4-week feeding for necropsy. The remaining rats were taken off ketamine for 8 weeks to allow for any potential recovery of pathological changes before being sacrificed for necropsy. Histopathological examination was performed on the kidney and urinary bladder. RESULTS: Submucosal bladder inflammation was seen in 67% of the rats fed with 300 mg/kg illicit ketamine. No bladder inflammation was observed in the control and 100 mg/kg illicit ketamine groups. Renal changes, such as interstitial nephritis and papillary necrosis, were observed in rats given illicit ketamine. After ketamine cessation, no inflammation was observed in the bladder of all rats. However, renal inflammation remained in 60% of the rats given illicit ketamine. No dose-effect relationship was established between oral ketamine and changes in the kidneys. CONCLUSION: Oral ketamine caused pathological changes in the urinary tract, similar to that described in exposure to parenteral ketamine. The changes in the urinary bladder were reversible after short-term exposure.

Tumour necrosis factor receptor-associated factor-1 (TRAF-1) expression is increased in renal cell carcinoma patient serum but decreased in cancer tissue compared with normal: potential biomarker significance.

Renal cell carcinoma (RCC) generally has a poor prognosis because of late diagnosis and metastasis. We have previously described decreased tumour necrosis factor receptor-associated factor-1 (TRAF-1) in RCC compared with paired normal kidney in a patient cohort in Australia. In the present study, TRAF-1 expression in clear cell RCC (ccRCC) and normal kidney was again compared, but in a cohort from University Malaya Medical Centre. Serum TRAF-1 was also evaluated in RCC and normal samples.Immunohistochemistry with automated batch staining and Aperio ImageScope morphometry was used to compare TRAF-1 in 61 ccRCC with paired normal kidney tissue. Serum from 15 newly diagnosed and untreated ccRCC and 15 healthy people was tested for TRAF-1 using ELISA.In this cohort, TRAF-1 was highly expressed in proximal tubular epithelium of normal kidney, and significantly decreased in ccRCC tissue (p < 0.001). Conversely, TRAF-1 in serum from ccRCC patients was significantly increased over control serum (132 ±â€Š30 versus 54 ±â€Š14 pg/mL, respectively; p = 0.013).Decreased TRAF-1 in RCC tissue, reported previously, was confirmed. This, along with significantly increased serum TRAF-1 may indicate the protein is actively secreted during development and progression of ccRCC. Therefore, the increased serum TRAF-1 may be a useful non-invasive indicator of RCC development.

The efficacy of periprostatic local anaesthetic infiltration in transrectal ultrasound biopsy of prostate: a prospective randomised control study.

OBJECTIVE: It is still uncertain as to which form of anaesthesia is the optimum. We conducted a study to identify the best location and optimum volume of anaesthetic agent in order to achieve best pain relief and cooperation from our patients. We also assessed the need for local anaesthetic gel for probe lubrication and if the number of cores during biopsy makes a difference in the pain score. MATERIALS AND METHOD: A total of 386 patients were randomised into 4 groups i.e. no anaesthesia (Group A), 10 cc 1% Lignocaine at apical region of prostate (Group B), 5 cc 1% Lignocaine each at both bases (Group C) and lastly, 4 cc at apex and 3 cc each at both bases (Group D). Pain assessment was performed using the 10-point Visual Analog Scale after the procedure with regard to probe insertion and during the biopsy. RESULTS: The groups were comparable in number and mean age. Group B recorded the lowest mean pain score of 2.59. Comparative analysis showed significant pain relief when comparing Group B vs. Group A (P = 0.001). The other groups were not as effective. The overall mean pain score for the probe insertion and the number of cores during biopsy was also not significant. CONCLUSIONS: We suggest that a 10 cc 1% Lignocaine infiltration at the apical region of the prostate be used to obtain best pain relief during this procedure. Plain lubricant jelly is sufficient for probe insertion. There is no need to alter the anaesthetic requirement if number of cores is increased.

Granulomatous prostatitis: a reminder to clinicians.

Granulomatous Prostatitis (GnP) is a heterogenous entity classified into specific infections, non-specific infections, post surgical i.e. post-transurethral resection of prostate (TURP) and rare secondary (systemic) causes. A total of 1388 reports of prostatic biopsy and prostatic chips from TURP were reviewed from 1995 and 2007. The results which showed granulomatous prostatitis were analyzed and retrospective data collected from the patient's records. A total of 9 cases with granulomatous prostatitis were identified. There are 3 types of entities which are the non-specific (NSGnP), post-TURP and the specific type. The incidence of GnP in our center is lower than reported by Stillwell et al. The majority of the patients were Malays.

Reliability and validity of the Spielberger State-Trait Anxiety Inventory (STAI) among urological patients: a Malaysian study.

To validate the English version of the Spielberger State-Trait Anxiety Inventory (STAI) in a sample of Malaysia patients with and without urinary symptoms. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with LUTS who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 40 items with Cronbach's alpha value = 0.38 to 0.89 while the Cronbach's alpha for the total scores was 0.86. Test-retest correlation coefficients for the 40 items score were highly significant. Intraclass correlation coefficient was high (ICC=0.39 to 0.89). A high degree of sensitivity and specificity to the effects of treatment was observed. A high degree of significant level between baseline and post-treatment scores was observed across nearly half of the items in surgical group but not in the non-LUTS group (control subjects). The STAI is reliable, valid and sensitive to clinical change in a sample of Malaysian patients with and without urinary symptoms.

Evaluation of live renal donors with three-dimensional contrast-enhanced magnetic resonance angiography in comparison to catheter angiography.

BACKGROUND: Catheter angiography is traditionally used to determine renal arterial anatomy in live renal donors. Three-dimensional (3D) contrast-enhanced magnetic resonance imaging (MRA) has been suggested as a noninvasive replacement. We assessed the possibility of using MRA in live renal donors in Malaysia. METHODS: Twenty-six consecutive live renal donors were recruited from 2000 to 2002. All potential donors underwent evaluation of the renal arteries using both techniques. Angiographic findings from both modalities were subsequently compared with surgical findings at the time of donor nephrectomy. The total number and diameter of the arteries and the presence of early branching and renal abnormalities were noted. RESULTS: Both angiographic modalities were able to detect multiple renal arteries with catheter angiography having a sensitivity of 100% and MRA a sensitivity of 97%. MRA missed one 1-mm artery due to a low index of suspicion. Renal artery caliber measurements were not significantly different between the two methods. However, both techniques tended to overestimate the caliber of the renal arteries when compared with measurements taken at surgery. Early branching was found in two arteries at the time of surgery, but only one was detected by both techniques. Renal cysts seen on MR were not detected by catheter angiography. CONCLUSIONS: Our findings suggest that noninvasive MRA is a promising substitute for catheter angiography to evaluate the renal arteries of live donors.

The sensitivity of the Malay version of Brief Manual of Sexual Function Inventory in assessing erectile dysfunction secondary to benign prostatic hyperplasia.

This study aimed to assess the sensitivity of the Malay version of the Brief Manual Sexual Function Inventory (BMSFI) on patients with and without urinary symptoms in Malaysian population. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability and validity was evaluated by using the test-retest method while internal consistency was assessed by Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in patients who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 11 items and 5 domains (Cronbach's alpha value = 0.67 and higher and 0.73 and higher respectively). Test-retest correlation coefficient for the 11 items scores was highly significant. Intraclass correlation coefficient was high (ICC = 0.68 and above). The sensitivity and specificity showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post-treatment scores were observed across 3 domains in the treatment corresponds cohort but not in the control group. The Mal-BMSFI is a suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Sexual function outcomes following treatment for lower urinary tract symptoms. A one-year study.

The aim of this study was to assess the effects of treating lower urinary tract symptoms (LUTS) on the quality of sexual function in a one-year follow up. A total of 116 patients with LUTS received alpha-blocker treatment, 111 patients underwent transurethral resection of the prostate (TURP) and 70 patients with renal stones, with no or mild symptoms served as a control group. The patients were assessed at baseline, three months, six months and twelve months using the International Index of Erectile Function (IIEF-15). The surgical group exhibited some changes in the domain of IIEF-15. Patients in the medical group showed improvement in erectile function and intercourse satisfaction, while orgasmic, overall sexual satisfaction and sexual drive were relatively unchanged. In contrast, the surgical group suffered retrograde ejaculation and overall sexual dissatisfaction after undergoing TURP. TURP has been found to be associated with retrograde ejaculation intercourse and overall sexual dissatisfaction.

Reliability and validity of the Malay version of the International Index of Erectile Function (IIEF-15) in the Malaysian population.

The objective of this study was to validate the Malay version of the International Index of Erectile Function (IIEF-15) in patients with lower urinary tract symptoms. Reliability and validity was assessed by using the test-retest while Cronbach's alpha was used to assess internal consistency. Effect size 5was evaluated to assess the sensitivity to change in the pre-transurethral resection of the prostate (TURP) vs post-TURP. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 15 items and five domains (Cronbach's alpha value=0.56 and higher and 0.74 and higher, respectively). Test-retest correlation coefficient for the 15 items and domains scores showed no significant changes. Intraclass correlation coefficient for 15 items and domains were high (ICC=0.59 and above). It can be concluded that the Mal-IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Reliability and validity of the Malay version of the Health-Related Quality of Life instrument in a Malaysian population.

OBJECTIVE: To validate the Malay version of the Health-Related Quality of Life (Mal-HRQOL-20) questionnaire in patients with and without urinary symptoms in a Malaysian population. PATIENTS AND METHODS: The validity and reliability of the Mal-HRQOL-20 were assessed in patients with and without lower urinary tract symptoms (LUTS). The reliability was evaluated using the test-retest method and the internal consistency using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the score before and after intervention in additional patients with LUTS who underwent transurethral resection of the prostate. RESULTS: The internal consistency was excellent; there was a high degree of internal consistency for each of the 20 items and for the overall score (Cronbach's alpha > or = 0.57 and 0.79, respectively) in the population study. The test-retest correlation coefficient for the 20 item scores was highly significant. The intra-class correlation coefficient was high (> or = 0.55). The sensitivity and specificity were high for the effects of treatment. There was a very significant agreement between scores before and after treatment across all domains in the treatment cohort, but not in the control group. CONCLUSION: The Mal-HRQOL-20 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

The performance properties of the International Index of Erectile Function (IIEF-15) in assessing erectile dysfunction in patients with lower urinary tract symptoms.

To validate the International Index of Erectile Function (IIEF-15) in Malaysian population. Reliability and internal consistency were evaluated using the test-retest method and Cronbach's alpha. Sensitivity to change was expressed as the effect size index. Internal consistency was excellent (Cronbach's alpha value = 0.75 to 0.90) Test-retest correlation coefficient and intraclass correlation coefficient were highly significant (ICC = 0.75 and above) and a high degree of sensitivity and specificity was observed. The IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

The effects of treating lower urinary tract symptoms on health-related quality of life: a short-term outcome.

OBJECTIVES: This study examined the effects of treatment of lower urinary tract symptoms (LUTS) on the health-related quality of life (physical/functional, mental, social and global aspect), pain and prostatic symptoms. PATIENTS AND METHODS: The study consisted of 123 LUTS patients on medical treatment (alpha blockers) and 52 who underwent surgical treatment (TURP). The patients were assessed one week before and three months after medical and surgical treatment by using the Health-Related Quality of Life (HRQOL-20), the Visual Analogue Scale of Pain (VAS), the Present Pain Intensity (PPI) and the International Prostate Symptom Score (I-PSS) inventories and questionnaires. RESULTS: Prior to treatment, the surgically treated patients were found to suffer more pain, severe prostatic symptoms, bothersomeness and deterioration in health-related quality of life than the medically treated patients. Postoperatively, the surgical group showed a significant reduction and improvement in all aspects of pain, prostatic symptoms, bothersomeness and overall health-related quality of life, as compared with the medication group. The mean ages of the surgical and medical treated groups were 69.56 years (SD=7.94 years) and 64.62 years (SD=7.94 years) respectively. CONCLUSIONS: The result showed that operative procedure had significantly improved the overall health-related quality of life of LUTS patients compared to those on medical treatment.

Reliability and Validity of the Malay Version of the General Health Questionnaire (GHQ - 12) Among Urological Patients.

The aim of the study was to validate the Malay version of the General Quentionnaire (GHQ-12) in patients with psychiatric morbidity secondary to urological disorder. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items and total scores (Cronbach's alpha value = 0.50 and higher and 0.65 respectively. Test-retest correlation coefficient for the 12 items scores was highly significant. Intraclass correlation coefficient was high (ICC=0.47 and above). A significant level between baseline and post-treatment scores were observed across 3 items in the surgical group. The Mal-GHQ-12 is a suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Beck Depression Inventory (BDI): a reliability and validity test in the Malaysian urological population.

This study aimed to validate the Beck Depression Inventory (BDI) in the Malaysian urological population. Reliability and internal consistency were evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was high (Cronbach's alpha value = 0.56 to 0.87). Test-retest correlation coefficient and intraclass correlation coefficient were significant (ICC = 0.56 to 0.87) and a high degree of sensitivity and specificity. The BDI is thus a reliable and a valid instrument to be used in Malaysia.

A Malaysian Study on the reliability and validity of the Health-Related Quality of Life Questionnaire (HRQOL-20) in urological patients.

Main objective of this study is to validate the Health-Related Quality of Life (HRQOL-20) in the Malaysian population. Reliability and internal consistency were evaluated using the test-retest method and Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was excellent (Cronbach's alpha value = 0.68 to 0.87). Test-retest correlation coefficients and intraclass correlation coefficient were significant (ICC = 0.58 and 0.91) as well as the high degree of sensitivity and specificity. The HRQOL-20 is a reliable, valid and sensitive to clinical changes in the Malaysian urological population.

Reliability and validity of the General Health Questionnaire (GHQ-12) among urological patients: a Malaysian study.

This present study was undertaken to validate the English version of the General Health Questionnaire (GHQ-12) in urological patients. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items with Cronbach's alpha value of 0.37-0.79, while total scores was 0.79 in the population study. Test-retest correlation coefficient for the 12 items score were highly significant. Intraclass correlation coefficient was high (0.35-0.79). It showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post-treatment scores were observed across all 12 items in the treatment cohort but not in the control group. The GHQ-12 is suitable, reliable, valid and sensitive to clinical change in urological disorders.