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  1. Ng KL, Chua CB
    Asian J Surg, 2017 Apr;40(2):163-165.
    PMID: 25183290 DOI: 10.1016/j.asjsur.2014.01.016
    Intravesical Bacillus Calmette-Guérin (BCG) has been a proven and effective immunotherapy treatment for superficial transitional cell carcinoma (TCC) of the bladder, especially for high-grade tumors and carcinoma in situ. Nevertheless, significant side effects are associated with BCG instillations, including fever, myalgia, malaise, dysuria, hematuria, and irritable lower urinary tract symptoms. We herein report the case of a patient who developed Reiter's syndrome following intravesical BCG instillations. A 39-year-old Chinese man presented with a 3-week history of dysuria, suprapubic pain, and pain at the tip of the penis postmicturition. Initial investigations revealed that he had microhematuria, and an ultrasound with computed tomography scan of the abdomen showed a bladder mass. Transurethral resection of the bladder tumor was performed and the patient received a single dose of intravesical mitomycin postoperatively. Results of histopathological examination revealed high-grade bladder TCC (G3pT1), and the patient was managed with intravesical BCG for 2 weeks following the surgery. Four weekly cycles of BCG were administered uneventfully; however, before the fifth instillation, the patient complained of urethral discharge, bilateral conjunctivitis, and low back pain. Reiter's syndrome was diagnosed as a rare but known complication of BCG instillation and the BCG immunotherapy was withheld. The patient was treated with nonsteroidal antiinflammatory drugs (for back pain) and eye ointment (for conjunctivitis) and his condition improved. This case report of Reiter's syndrome should be highlighted as a rare but significant complication of BCG immunotherapy and urologists should have a high index of suspicion to diagnose this rare complication.
  2. Quek KF, Sallam AA, Ng CH, Chua CB
    J Sex Med, 2008 Jan;5(1):70-6.
    PMID: 17362280 DOI: 10.1111/j.1743-6109.2006.00423.x
    INTRODUCTION: Sexual problems are common in the general population. Studies have shown that most of these sexual problems are related to their social lives, medical illnesses, and psychological status. Among the sexual problems in men, premature ejaculation (PE) is one of the most frequent, yet it is the least well-understood of the sexual dysfunctions of men.
    AIM: To determine the prevalence of sexual problem particularly PE and erectile dysfunction (ED) among people living in urban areas and to investigate the characteristics associated with these sexual problems in a Malaysian population.
    MAIN OUTCOME MEASURE: The PE which is defined as an intravaginal ejaculation latency time less than 2 minutes was assessed in the ED and non-ED group.
    METHODS: The Hospital Anxiety and Depression scale is used as a measure of the psychological status [30]. The ED status was assessed using the International Index of Erectile Function questionnaire.
    RESULTS: The prevalence of self-reported sexual problems for ED and PE were 41.6% and 22.3%, respectively. In those subjects with ED, 33.5% reported to have PE. Of the total of 430 subjects, anxiety was present in 8.1%, while depression was 5.3%. The prevalence of PE accounted for 25% anxiety and 14.6% for depression respectively in the population. EDs were associated with diabetes and hypertension (OR [95% CI]: 5.33 [2.33, 10.16], 3.40 [1.76, 6.57], P < 0.05), respectively, while factors associated with PE were anxiety and depression (OR [95% CI]: 1.29 [0.68, 2.45], 1.39 [0.69, 2.78]), respectively.
    CONCLUSION: Prevalence of ED is associated with medical symptoms such as diabetes and hypertension and a rise in the prevalence of age while psychological distress such as anxiety and depression also contribute to a higher PE rate.
  3. Lee PY, Ong TA, Chua CB, Lei CCM, Teh GC
    Malays Fam Physician, 2009;4(1):15-8.
    PMID: 25606152 MyJurnal
    INTRODUCTION: Ketamine is frequently abused nowadays as a recreational drug. Case reports are emerging since 2007 to describe a new clinical entity of severe bladder dysfunction associated with chronic abuse of street ketamine.
    CLINICAL PRESENTATION: Severe lower urinary tract symptoms of urinary frequency and urgency which are refractory to conventional treatment. Quality of life is adversely affected as a consequence. Chronic kidney disease will develop in advanced cases. Investigation findings: The urine is sterile on culture. Ultrasound will show reduced bladder capacity with thickened bladder wall. In advanced stage, hydronephrosis and renal impairment will develop.
    TREATMENT: Patients should be advised to stop street ketamine use immediately. Anticholinergic medication could be tried to alleviate the symptoms. Refractory cases with dilatation of the upper urinary tract might need urinary diversion.
    CONCLUSION: Awareness of this new condition is essential in diagnosis. Early intervention offers better treatment outcome.
    KEYWORDS: Ketamine; bladder dysfunction; lower urinary tract symptoms
  4. Quek KF, Low WY, Razack AH, Loh CS, Chua CB
    Med J Malaysia, 2004 Jun;59(2):258-67.
    PMID: 15559178 MyJurnal
    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.
  5. Gan WH, Thye YL, Chang SH, Chua CB, Looi LM, Tan SY
    Transplant Proc, 2004 Sep;36(7):2148-9.
    PMID: 15518779
  6. Quek KF, Razack AH, Chua CB, Low WY, Loh CS
    Int J Urol, 2004 Oct;11(10):848-55.
    PMID: 15479289
    The present study aimed to evaluate the effects of treating lower urinary tract symptoms (LUTS) on anxiety, depression and psychiatric morbidity following one year of follow-up.
  7. Quek KF, Low WY, Razack AH, Chua CB, Loh CS
    Med J Malaysia, 2002 Jun;57(2):169-77.
    PMID: 24326647
    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.
  8. Quek KF, Low WY, Razack AH, Sin Loh C, Chua CB
    J Urol, 2002 Mar;167(3):1359-62.
    PMID: 11832732
    PURPOSE: We validated the Malay version of the International Prostate Symptom Score in patients with and without urinary symptoms in the Malaysian population.

    MATERIALS AND METHODS: Validity and reliability were studied in patients with and without lower urinary tract symptoms. Reliability was evaluated using the test-retest method and 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 additional patients with lower urinary tract symptoms who underwent transurethral prostate resection.

    RESULTS: Internal consistency was excellent. A high degree of internal consistency was observed for each of the 7 items and for the total score (Cronbach's alpha 0.53 and greater, and 0.68, respectively). The test-retest correlation coefficients of the 7 items were highly significant. The intraclass correlation coefficient was high at 0.51 and greater. There was a high degree of sensitivity and specificity to the effects of treatment. Significant change from baseline to posttreatment scores was observed in all 8 items in the treated but not in the control group.

    CONCLUSIONS: The Malay International Prostate Symptom Score is a suitable, reliable, valid instrument that is sensitive to clinical change in the Malaysian population.

  9. Quek KF, Low WY, Razack AH, Chua CB, Loh CS
    J Sex Marital Ther, 2002 Oct-Dec;28(5):423-6.
    PMID: 12378843
    The purpose of this study is to validate the English version of the Golombok-Rust Inventory of Marital State (GRIMS) in a Malaysian population. Using the test-retest method and Cronbach's alpha, we assessed reliability and internal consistency. Sensitivity to change was expressed as the effect size. Internal consistency was excellent (Cronbach's alpha value = 0.59 to 0.91) Test-retest correlation coefficient and intraclass correlation coefficient were highly significant in majority items (ICC = 0.62 and above), and there was a high degree of sensitivity and specificity. The GRIMS is suitable, reliable, valid, and sensitive to clinical change in a Malaysian population.
  10. Quek KF, Low WY, Razack AH, Loh CS, Chua CB
    Asia Pac J Public Health, 2000;12(2):107-17.
    PMID: 11836919 DOI: 10.1177/101053950001200210
    This study aims to assess the impact of medical and surgical treatment on treating lower urinary tract symptoms (LUTS) on pain, prostatic symptoms, disease-specific quality of life and health-related quality of life. Patients scheduled for medical (alpha-blockers) and surgical treatment (transurethral resection of the prostate, TURP) were recruited in the study. The patients were assessed using the Visual Analogue Scale (VAS), Present Pain Intensity (PPI), International Prostate Symptom Score (I-PSS) and Health-Related Quality of Life (HRQOL) at 3-month, 6-month and 12-month (baseline). Before treatment, most of the patients with LUTS had severe pain, LUTS and deterioration of health-related quality of life. Following treatment, both medical and surgical treatment improved their pain, LUTS and health-related quality of life. Both treatments are effective in relieving the symptoms of pain, LUTS and health-related quality of life.
  11. Quek KF, Chua CB, Low WY, Razack AH, Loh CS
    BJU Int, 2002 Jul;90(1):37-40.
    PMID: 12081766
    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.

  12. Quek KF, Low WY, Razack AH, Chua CB, Loh CS, Dublin N
    Med J Malaysia, 2002 Dec;57(4):445-53.
    PMID: 12733169
    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.
  13. Quek KF, Razack AH, Chua CB, Low WY, Loh CS
    Med J Malaysia, 2003 Dec;58(5):735-42.
    PMID: 15190661
    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.
  14. Quek KF, Low WY, Razack AH, Chua CB, Loh CS
    Med J Malaysia, 2003 Aug;58(3):356-64.
    PMID: 14750375
    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.
  15. Quek KF, Low WY, Razack AH, Chua CB, Loh CS
    Int J Impot Res, 2002 Aug;14(4):310-5.
    PMID: 12152122
    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.
  16. Quek KF, Chua CB, Razack AH, Low WY, Loh CS
    Int J Urol, 2005 Jan;12(1):39-45.
    PMID: 15661053 DOI: 10.1111/j.1442-2042.2004.00988.x
    The purpose of the present study was to validate the Mandarin version of the International Prostate Symptom Score (Mand-IPSS) in a Malaysian population.
  17. Quek KF, Loh CS, Low WY, Razack AH, Chua CB
    Singapore Med J, 2002 Aug;43(8):391-8.
    PMID: 12507023
    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.
  18. Tan SP, Bux SI, Kumar G, Razack AH, Chua CB, Lee SH, et al.
    Transplant Proc, 2004 Sep;36(7):1914-6.
    PMID: 15518697
    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.
  19. Tan HM, Chin CM, Chua CB, Gatchalian E, Kongkanand A, Moh CL, et al.
    Asian J Androl, 2008 May;10(3):495-502.
    PMID: 18385912 DOI: 10.1111/j.1745-7262.2008.00388.x
    To evaluate the efficacy and tolerability of vardenafil, a phosphodiesterase type-5 (PDE-5) inhibitor, in men of Asian ethnicity with erectile dysfunction (ED).
  20. Saad M, Alip A, Lim J, Abdullah MM, Chong FLT, Chua CB, et al.
    BJU Int, 2019 09;124(3):373-382.
    PMID: 31077523 DOI: 10.1111/bju.14807
    OBJECTIVE: To examine the results of the Malaysian Advanced Prostate Cancer Consensus Conference (MyAPCCC) 2018, held for assessing the generalizability of consensus reached at the Advanced Prostate Cancer Consensus Conference (APCCC 2017) to Malaysia, a middle-income country.

    METHODS: Six key sections were chosen: (1) high-risk localized and locally advanced prostate cancer, (2) oligometastatic prostate cancer, (3) castration-naïve prostate cancer, (4) castrate resistant prostate cancer, (5) use of osteoclast-targeted therapy and (6) global access to prostate cancer drugs. There were 101 consensus questions, consisting of 91 questions from APCCC 2017 and 10 new questions from MyAPCCC 2018, selected and modified by the steering committee; of which, 23 questions were assessed in both ideal world and real-world settings. A panel of 22 experts, comprising of 11 urologists and 11 oncologists, voted on 101 predefined questions anonymously. Final voting results were compared with the APCCC 2017 outcomes.

    RESULTS: Most voting results from the MyAPCCC 2018 were consistent with the APCCC 2017 outcomes. No consensus was achieved for controversial topics with little level I evidence, such as management of oligometastatic disease. No consensus was reached on using high-cost drugs in castration-naïve or castration-resistant metastatic prostate cancer in real-world settings. All panellists recommended using generic drugs when available.

    CONCLUSIONS: The MyAPCCC 2018 voting results reflect the management of advanced prostate cancer in a middle-income country in a real-world setting. These results may serve as a guide for local clinical practices and highlight the financial challenges in modern healthcare.

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