The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods
of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the
combination total intravenous anaesthesia and apneic pause technique with or without steroid injection.
Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric
cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and
after dilatation, number of dilatation were observed and compared. The outcome measures are
decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the
patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while
the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by
total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for
the narrowed airway.
Pros and cons of Percutaneous Nephrolithotripsy (PCNL) versus Extracorporeal Shockwave Lithotripsy (ESWL) have often been highlighted when one discusses on the management of renal stones. An oft quoted point is that PCNL entails a prolonged hospital stay whereas ESWL sessions are day surgical in nature. However, PCNL has superior stone clearance rate as compared to ESWL especially for lower pole stones. In addition, PCNL is more suitable for large bulk stones and when ancillary procedures are required e.g. endopyelotomy. The first 50 cases of successful tubeless PCNL were reported by Bellman et al in 1997. The remarkable recovery of patients in their series encouraged them to employ this technique as their technique of choice for the majority of their cases. A similar technique was employed on endopyelotomy by Liang et al and they concluded that this was a safe, less morbid and effective technique. We report our first case of tubeless PCNL.
We report a case of bladder outflow obstruction presenting with upper tract dilatation mistaken initially as pelviureteric junction (PUJ) obstruction. The lower tract obstruction ought to be dealt with first before upper tract obstruction is assessed because the renal pelvic pressure is significantly affected by vesical filling and high bladder pressure.
Fracture of the penis is not an uncommon urological emergency. Six patients with this injury, treated at the Institute of Urology, General Hospital, Kuala Lumpur, since 1988, were reviewed. Their ages ranged from 21 to 30 years old (mean 25). Four cases were self-inflicted by abnormal bending and 2 cases occurred during sexual intercourse. A sudden "cracking sound", violent pain, rapid flaccidity and deformity of the penis were documented. Duration of injury at presentation ranged from 12 to 90 hours (mean 35 hours). Primary repair of the tunica albuginea with absorbable suture was performed in all cases. The results of surgery was excellent, with restoration of normal function in 4 patients (2 patients defaulted follow-up). We advocate immediate surgical repair for this injury.
This case report illustrates how a life-threatening renal bleeding which has failed to be controlled by open surgery can be elegantly managed by a minimally invasive technique of interventional radiology. It also allows maximal conservation of renal tissue so that the patient can avoid chronic dialysis or renal transplantation.
Objective: To study the prevalence of symptomatic BPE among Malaysian men age 50 and above attending prostate health awareness campaign and to identify differences in prevalence between different ethnic groups residing within metropolitan Kuala Lumpur.
Materials and Methods: Demographic data and the completed International Prostate Symptom Score (IPSS), maximal uroflow rate (Qmax) and prostate size of volunteers, aged 50 and above, who attended the prostate health awareness campaign were analyzed. Subjects with known prostate diseases or prostate surgery, bladder disorders and neurological disorders were excluded.
Results: 2086 volunteers attended the campaign. 575 men fulfilled the inclusion criteria and their demographic data, IPSS; peak flow rate and prostate volume were analysed. Overall, 18.9% and 39.6% of the men were severely and moderately symptomatic, respectively. The prevalence of moderate to severe lower urinary tract symptoms (LUTS) in Malays, Chinese and Indians were 70%, 59% and 50% respectively (p=0.004). The commonest bothersome symptoms were nocturia (56%), frequency (50.4%) and sense of incomplete voiding (43.5%). The mean peak flow rate of the subjects was 15.4ml/s. 20.9% and 55.2% of the subjects had peak flow less than 10ml/sec and 15ml/sec respectively. The mean prostate size was 25.1cc. There is no significant difference in term of maximal flow rate and prostate size among Malays, Chinese and Indians in Malaysia. A good correlation was found between the total symptom score and the single disease-specific quality of life question (r=0.69, p<0.001). The correlation between IPSS and peak flow rate (r=-0.22, p<0.001) and prostate volume (r=0.11, p=0.009) was weak. There was no correlation between IPSS and age (r=0.06, p=0.17). The prevalence of symptomatic benign prostate enlargement (BPE) was 39.3%. The prevalence increased 8% per decade from 41.7% for men aged 50 to 59 to 65.4% for men aged 70 or more. There is no significant difference in prevalence of symptomatic BPE among the three ethnic groups. The prevalence of BPO was 15.8%.
Conclusion: The correlation between symptom score, maximal flow rate and prostate size was poor and one cannot predict the value of one parameter by knowing one or more of the other parameters. There is a high prevalence of LUTS suggestive of benign prostatic obstruction in the apparently healthy Malaysian aged 50 and above attending the prostate health awareness campaign.
DRE has been used as a diagnostic and screening tool for prostate cancer for decades. However these are based on Western data and its local applicability has yet to be verified. We held a Prostate Health Awareness Week in August 1998 and a total of 2086 men were screened. All men aged 50 years old and above were included for the study. The subjects were evaluated on DRE findings, PSA levels and if indicated a TRUS-guided biopsy results. We concluded that DRE per se might have limited role in the screening of prostate cancer in Malaysia. Screening using DRE and PSA combined are still recognized as the most cost-effective means. Neither DRE nor PSA alone has high enough specificity for diagnosis of prostate cancer cases. Combining DRE and PSA will definitely increase the specificity significantly.
Study site: e Urology
Clinic of Kuala Lumpur Hospital