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Fulltext Hand-assisted laparoscopic nephrectomy and nephroureterectomy: our experience in Hospital Universiti Kebangsaan Malaysia

Ho CC, Zulkifli MZ, Nazri J, Sundram M

Med J Malaysia, 2008 Mar;63(1):41-3.
PMID: 18935731

Hand-assisted laparoscopic nephrectomy (HAL-N) and nephroureterectomy (HAL-NU) were introduced to bridge the gap between open and laparoscopic surgery. This newer technique has the benefits of both laparoscopic and open surgical approaches but has a shorter learning curve and decreased operative time compared to laparoscopic surgery. A review of our 2-year experience showed that for the seventeen cases of HAL-N that was performed, the mean operative time was 187.8 minutes while the mean length of hospital stay was 4.1 days. For the two HAL-NU cases, the mean operative time was 415 minutes while the mean length of hospital stay was 5.5 days. Only one complication occurred and it was an incisional hernia at the hand-port site. There was no recurrence for the carcinoma cases. Our experience shows that this technique is feasible and safe.
Fulltext Predicting outcome of trial of voiding without catheter in acute urinary retention with intravesical prostatic protrusion

Syazarina Sharis O, Zulkifli MZ, Hamzaini AH

Malays J Med Sci, 2013 Jan;20(1):56-9.
PMID: 23785255 MyJurnal

Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient's age were also assessed.
S-band multiwavelength ring Brillouin/Raman fiber laser with 20 GHz channel spacing

Ahmad H, Zulkifli MZ, Hassan NA, Harun SW

Appl Opt, 2012 Apr 10;51(11):1811-5.
PMID: 22505174 DOI: 10.1364/AO.51.001811

We propose and demonstrate a tunable S-band multiwavelength Brillouin/Raman fiber laser (MBRFL) with a tuning range of between 1490 to 1530 nm. The proposed MBRFL is designed around a 7.7 km long dispersion compensating fiber in a simple ring configuration, acting as a nonlinear medium for the generation of multiple wavelengths from stimulated Brillouin scattering (SBS) and also as a nonlinear gain medium for stimulated Raman scattering (SRS) amplification. A laser source with a maximum power of 12 dBm acts as the Brillouin pump (BP), while two 1420 nm laser diodes with a total power of 26 dBm act as the Raman pumps (RPs). The MBRFL can generate a multiwavelength comb consisting of even and odd Stokes at an average power of -12 dBm and -14 dBm respectively, and by separating the even and odd Stokes outputs, a 20 GHz channel spacing is obtained between two consecutive wavelengths. Due to the four-wave mixing (FWM) effect, anti-Stokes lines are also observed. The multiwavelength comb generated is not dependent on the BP, thus providing high stability and repeatability and making it a highly potential source for many real-world applications. This is the first time, to the knowledge of the authors, that a tunable MBRFL has been developed using SRS to obtain gain in the S-band region.
Ureteric stone in the presence of existing backache: lessons to learn

Zulkifli MZ, Ho CC, Goh EH, Praveen S, Das S

Clin Ter, 2012;163(1):23-5.
PMID: 22362229

Incidence of urolithiasis is on the rise due to climatic changes especially global warming.The pain due to presence of ureteric stone is a well known identity but many times it may be asymptomatic or even masked by concurrent presence of backache. In the present article, we describe the case of a 43-year-old male who came to the clinic for treatment of backache persisting for more than two years. The patient complained of backache two years back for which he was treated with analgesics and physiotherapy which relieved his pain. No X-ray was taken earlier because the attending clinician thought the backache to be musculo-skeletal in origin. Recently, one day a sudden episode of backache in the midst of night compelled him to seek medical treatment. However, this time a X-ray was performed and it showed the presence of calculi in the right upper pelvis of ureter which measured 1.9 cm vertically. An ultrasound confirmed the diagnosis. The patient was treated with two episodes of shock wave therapy which failed to crush the stone. A Double-J stent was inserted under general anaesthesia. The stone was crushed using a ureteroscope guided laser. The present case report describes how backache in professionals cannot be lightly attended. Even the characteristic groin to loin pain may be absent. All cases of backache should be properly investigated with an X-ray to rule out renal or ureteric calculi.
Fulltext Granulomatous prostatitis: a reminder to clinicians

Shanggar K, Zulkifli MZ, Razack AH, Dublin N

Med J Malaysia, 2010 Mar;65(1):21-2.
PMID: 21265242 MyJurnal

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.
Fulltext Metastatic penile cancer presenting as hypercalcemia and pathological fracture of the humerus: a rare event

Ho CC, Nazri J, Zulkifli MZ, Sritharan S, Hayati AR

Med J Malaysia, 2006 Oct;61(4):503-5.
PMID: 17243535 MyJurnal

Distant haematogenous metastasis in penile cancer is rare. A patient who had total penectomy and bilateral inguinal lymphadenectomy for penile cancer but later presented with hypercalcemia of malignancy and pathological fracture of the humerus is reported.
Fulltext A review of day care ureteroscopy of a teaching hospital in Malaysia

Chan KY, Zulkifli MZ, Nazri MJ, Rashid MO

Med J Malaysia, 2005 Mar;60(1):5-9.
PMID: 16250273 MyJurnal

This is a retrospective review of 200 day-care ureteroscopies performed between April 1998 and October 2002. The aim was to determine the feasibility and safety of this procedure. The mean age was 38.8 years and 75% of them were male. Eighty-three percent were ASA 1 and the remainders were ASA 2. The side of procedure were 48.5% right, 2.5% left and 6% both sides. Fentanyl and proprofol were used during induction. Calculi were found in 82.5% of cases. Rigid and flexible scope were used in 91.5% and 10.5% of cases. There were 33% upper, 23% mid and 44% distal ureteric stones. The mean stone size was 9.37 X 6.93mm. Seventy-four percent required a ureteric stent insertion. The mean operative time was 58.3 minutes. Four percent of patients experienced pain post-operatively relieved by NSAID injection. Repeat ureteroscopy performed in 30% of patients. There were zero admission rates. This study suggests day-care ureteroscopy is effective, safe and well tolerated by patients.
Fulltext D-Shaped Polarization Maintaining Fiber Sensor for Strain and Temperature Monitoring

Qazi HH, Mohammad AB, Ahmad H, Zulkifli MZ

Sensors (Basel), 2016 Sep 15;16(9).
PMID: 27649195 DOI: 10.3390/s16091505

A D-shaped polarization-maintaining fiber (PMF) as fiber optic sensor for the simultaneous monitoring of strain and the surrounding temperature is presented. A mechanical end and edge polishing system with aluminum oxide polishing film is utilized to perform sequential polishing on one side (lengthwise) of the PMF in order to fabricate a D-shaped cross-section. Experimental results show that the proposed sensor has high sensitivity of 46 pm/µε and 130 pm/°C for strain and temperature, respectively, which is significantly higher than other recently reported work (mainly from 2013) related to fiber optic sensors. The easy fabrication method, high sensitivity, and good linearity make this sensing device applicable in various applications such as health monitoring and spatial analysis of engineering structures.
Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia

Ho CC, Ngoo KS, Hamzaini AH, Rizal AM, Zulkifli MZ

Clin Ter, 2014;165(2):75-81.
PMID: 24770808 DOI: 10.7471/CT.2014.1680

OBJECTIVE: To determine the clinical utility of urinary bladder and prostate characteristics measured by ultrasound scan in predicting acute urinary retention (AUR) for men with bladder outlet obstruction with an underlying benign prostate hyperplasia (BPH).
MATERIALS AND METHODS: Consecutive men aged ≥50 years presenting with lower urinary tract symptoms (LUTS) or AUR were prospectively recruited in this cross-sectional study. International prostatic symptom score (IPSS) and serum prostate-specific antigen (PSA) were recorded. High-resolution ultrasound was used to measure bladder detrusor thickness (DT, mm), prostatic volume (PV, cm3), intravesical prostatic protrusion (IPP, mm), bladder wall thickness (BWT,mm), intravesical volume and bladder radius. The latter two parameters were used to estimate bladder weight (UEBW, g), assuming a spherical bladder.
RESULTS: Among selected patients, thirty had AUR while 32 men presented with LUTS only. There were significant differences between those with and without AUR in their age (70.5 vs 66.0, p=0.017), IPSS (24.0 vs 18.5, p=0.009), serum PSA (6.18 vs 1.77, p=0.002), PV (56.7 vs 32.4, p=0.006), BWT (5.0 vs 4.4, p=0.034) and UEBW (39.1 vs 25.0, p=0.0003). Multivariate analysis revealed high IPSS and UEBW to be predictors for AUR. UEBW was the strongest predictor of AUR: area under ROC curve was 0.767, with sensitivity and specificity of 63.3% and 87.5%, respectively, at cut-off point of 35 g. The likelihood ratio for AUR was also best with UEBW≥35 g.
CONCLUSIONS: Combined with IPSS, ultrasound determined bladder characteristic, particularly UEBW, is a useful tool in predicting AUR in men with BPH.
Bilateral emphysematous pyelitis: a rare encounter in urology

Tan C C K Ho GH, Bahadzor B, Praveen S, Goh EH, Syahril AS, Zulkifli MZ

Clin Ter, 2013;164(4):319-21.
PMID: 24045515 DOI: 10.7417/CT.2013.1580

Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.
Fulltext Temperature-insensitive bend sensor using entirely centered Erbium doping in the fiber core

Ahmad H, Zulkifli MZ, Muhammad FD, Samangun JM, Abdul-Rashid HA, Harun SW

Sensors (Basel), 2013;13(7):9536-46.
PMID: 23881146 DOI: 10.3390/s130709536

A fiber based bend sensor using a uniquely designed Bend-Sensitive Erbium Doped Fiber (BSEDF) is proposed and demonstrated. The BSEDF has two core regions, namely an undoped outer region with a diameter of about 9.38 μm encompassing a doped, inner core region with a diameter of 4.00 μm. The doped core region has about 400 ppm of an Er2O3 dopant. Pumping the BSEDF with a conventional 980 nm laser diode gives an Amplified Spontaneous Emission (ASE) spectrum spanning from 1,510 nm to over 1,560 nm at the output power level of about -58 dBm. The ASE spectrum has a peak power of -52 dBm at a central wavelength of 1,533 nm when not spooled. Spooling the BSEDF with diameters of 10 cm to 2 cm yields decreasing peak powers from -57.0 dBm to -61.8 dBm, while the central wavelength remains unchanged. The output is highly stable over time, with a low temperature sensitivity of around ~0.005 dBm/°C, thus allowing for the development of a highly stable sensor system based in the change of the peak power alone.
S-band multiwavelength Brillouin/Raman distributed Bragg reflector fiber lasers

Zulkifli MZ, Ahmad H, Taib JM, Muhammad FD, Dimyati K, Harun SW

Appl Opt, 2013 Jun 1;52(16):3753-6.
PMID: 23736330 DOI: 10.1364/AO.52.003753

A multiwavelength Brillouin/Raman distributed Bragg reflector fiber laser operating in the S-band region is proposed and demonstrated. The laser uses a 7.7 km long dispersion-shifted fiber with an effective mode area of 15 μm(2) as the Brillouin and Raman gain media simultaneously. Two 1420 nm laser diodes with a combined power of 372 mW are used as pump sources, while a fiber Bragg grating with a center wavelength of 1500 nm is used as a reflector in the cavity. The setup is capable of generating 6 clearly defined Stokes lines at the highest pump power, spanning from 1499.8 to 1500.3 nm with the even Stokes having relatively higher peak powers, between 1.4 and 3.5 dBm as compared to the odd Stokes, which have peak powers between -4.7 and -5.0 dBm. The output of the laser is very stable and shows little to no fluctuations over a monitoring period of 50 min.
Clinicopathological features and survival of testicular tumours in a Southeast Asian university hospital: a ten-year review

Tan GH, Azrif M, Shamsul AS, Ho CC, Praveen S, Goh EH, et al.

Asian Pac J Cancer Prev, 2011;12(10):2727-30.
PMID: 22320982

INTRODUCTION: Testicular cancer mainly affects young men worldwide. There is lack of published data on patients with this malignant condition from the Southeast Asian region. The aim of this study was therefore to determine the clinicopathologic features of testicular cancer patients treated in a Southeast Asian university hospital and their overall survival rate.
MATERIALS AND METHODS: This was a retrospective study of testicular cancer patients treated between January 2001 and February 2011. Their epidemiological data, clinical presentation, pathologic diagnosis, stage of disease and treatment were gathered and the overall survival rate of this cohort was analyzed.
RESULTS: Thirty-one patients were included in this study. The majority of them were of Malay ethnicity. The average age at presentation was 33.7 years. The commonest testicular cancer was non-seminomatous germ cell tumour, followed by seminoma, lymphoma and rhabdomyosarcoma. More than half of all testicular germ cell tumour (GCT) patients had some form of metastasis at diagnosis. All the patients were treated with radical orchidectomy. Adjuvant chemotherapy was given to those with metastatic disease. Four seminoma patients received radiotherapy to the para-aortic lymph nodes. The 5-year survival rate for all testicular cancers in this cohort was 83.9%. The survival rate was 88.9% in 5 years when GCT were analyzed separately.
CONCLUSION: GCT affects patients in their third and fourth decades of life while lymphoma patients are generally older. Most of the patients treated for GCT are of Malay ethnicity. The majority have late presentation for treatment. The survival rate of GCT patients treated here is comparable to other published series in other parts of the world.
Evaluation of power Doppler ultrasonography for prostate biopsy in men with elevated serum prostate specific antigen levels

Ho CC, Khor TW, Singam P, Goh EH, Tan GH, Bahadzor B, et al.

Clin Ter, 2012;163(3):211-4.
PMID: 22964693

OBJECTIVE: To evaluate power doppler ultrasonography (PDU)-directed prostate biopsy in patients with elevated serum prostate specific antigen (PSA) levels.
MATERIALS AND METHODS: Men with serum total PSA levels of more than 4 ng/ml undergoing biopsy for the first time were included. Grey-scale transrectal ultrasound (TRUS) and PDU were performed. PDU signal on vascularity accumulation and perfusion characteristics were recorded and graded as normal or abnormal in the peripheral zone of the prostate. Abnormalities were defined on transverse image as radial or arc hypervascularities. A biopsy regime based on Vienna-normogram was performed in all patients.
RESULTS: Overall, prostate adenocarcinoma detection rate was 21.4% and abnormal accumulation on PDU signal was identified in 96.7% of those patients (p = 0.01). PDU directed prostate biopsies were positive in 66.7% of the patients with prostate cancer. The sensitivity, specificity, positive predictive value and negative predictive value of PDU signal alone for prostate cancer detection was 96.7%, 24.5% and 96.4% respectively, and PDU guided biopsies were 66.7%, 24.5%, 19.4% and 73% respectively.
CONCLUSIONS: The high sensitivity and negative predictive value of PDU makes it useful as an aid for TRUS biopsy in selected patient with previous negative biopsies at risk of harbouring prostate cancer.
Fulltext Proptosis: a rare presentation of metastatic renal cell carcinoma

Ho CC, Krishna KK, Praveen S, Goh EH, Lee BC, Zulkifli MZ

Med J Malaysia, 2010 Sep;65(3):229-30.
PMID: 21939176

We present a case of a middle-aged man who was incidentally found to have right renal solid mass while investigating for his left eye proptosis. Computerised tomography (CT) scan confirmed the diagnosis of renal cell carcinoma and the tumour was successfully excised via open surgery. The histopathology examination revealed the 10x7x8 cm mass to be a clear cell type renal cell carcinoma. The rare presentation of this metastatic renal cell carcinoma, its diagnosis and management will be discussed.
An unusual cause of a penetrating injury to the anterior urethra: a thorny situation

Tan GH, Ho CC, Bahadzor B, Praveen S, Goh EH, Afdzillah AR, et al.

Clin Ter, 2013;164(1):35-7.
PMID: 23455741 DOI: 10.7417/T.2013.1509

Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.
Highly stable graphene-assisted tunable dual-wavelength erbium-doped fiber laser

Ahmad H, Latif AA, Abdul Khudus MI, Zulkifli AZ, Zulkifli MZ, Thambiratnam K, et al.

Appl Opt, 2013 Feb 1;52(4):818-23.
PMID: 23385923 DOI: 10.1364/AO.52.000818

A highly stable tunable dual-wavelength fiber laser (TDWFL) using graphene as a means to generate a highly stable output is proposed and generated. The TDWFL comprises a 1 m long, highly doped erbium-doped fiber (EDF) acting as the linear gain medium, with a 24-channel arrayed waveguide grating acting as a wavelength slicer as well as a tuning mechanism to generate different wavelength pairs. The tuned wavelength pairs can range from 0.8 to 18.2 nm. A few layers of graphene are incorporated into the laser cavity to induce the four-wave-mixing effect, which stabilizes the dual-wavelength output by suppressing the mode competition that arises as a result of homogenous broadening in the EDF.
Giant Urethral Calculus without Acute Urinary Retention

Abidin ZAZ, Hayati F, Tan GH, Goh EH, Hafidzul J, Zulkifli MZ

J Coll Physicians Surg Pak, 2018 Mar;28(3):S69-S70.
PMID: 29482714 DOI: 10.29271/jcpsp.2018.03.S69

A 46-year gentleman presented with a left-sided lumbar region pain without fever or dysuria. He denied episodes of acute urinary retention. There was a hard mass at the distal urethra with normal laboratory blood tests. Computed tomography urogram revealed a concurrent left renal staghorn calculus and large distal urethral stone. The urethral stone was fragmented via endourologic technique successfully. We report a case of a non-obstructing large urethral calculus in a gentleman with concurrent left renal staghorn calculus and discuss the literature review.
Initial experience of laparoscopic retroperitoneal partial nephrectomy in an academic hospital in Malaysia

Khoo HC, Lim LY, Shukor S, Zainal Adwin ZA, Zulkifli MZ, Fam XI

Med J Malaysia, 2022 Nov;77(6):764-767.
PMID: 36448397

Laparoscopic retroperitoneal partial nephrectomy (LRPN) is a technically demanding kidney surgery due to the limited space and unfamiliar approach in the retroperitoneal space. The aim of this study is to review the outcome of our initial experience in performing this procedure. All patients who underwent LRPN between 2019 to 2022 were included in this retrospective review. A total of 23 patients underwent LRPN. The mean operating time was 178±43 minutes and mean warm ischemia time was 20±5 minutes. The average estimated blood lost was 89±68ml and the mean postoperative hospital stay was 3.6±0.8 days. Two patients (11.1%) had positive margin and no local recurrence was seen after mean follow up of 15.8±12.0 months. Our initial experience on LRPN showed promising results to perform partial nephrectomy safely and effectively.
Fulltext Retrograde intrarenal surgery for renal stones smaller than 2 cm

Ho CC, Hafidzul J, Praveen S, Goh EH, Bong JJ, Lee BC, et al.

Singapore Med J, 2010 Jun;51(6):512-5.
PMID: 20658113

Extracorporeal shock wave lithotripsy (ESWL) is accepted as the gold standard treatment for renal stones that are smaller than 2 cm. Recently, retrograde intrarenal surgery (RIRS) has been introduced as another form of treatment. We report our experience in dealing with renal stones smaller than 2 cm using RIRS as the primary treatment and following failed ESWL.

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