Objectives To study the prevalence of symptoms of pro-statism in the community and the correlation between these symptoms and age, prostate volume, flow rate and residual urine volume.

Subjects and methods The International Prostate Symptom Score (IPSS) was administered to a community-based population of 502 men aged between 55 and 74 years with no prostate Cancer and no history of a prostate operation. Prostate volume parameters, flow rate variables and post-void residual urine volume were measured.

Results Overall, 6 and 24% of the men were severely and moderately symptomatic, respectively. The results of a detailed questionnaire such as the IPSS (only 12% of the men scored 0) contrast with the men's global perception of their voiding function (82% claimed to have ‘no voiding complaints’). A good correlation was found between the total symptom score and the single disease-specific quality of life question that is included in the IPSS (r= 0.74, P= 0.001). There was a weak correlation between the IPSS and total prostate volume (r= 0.19, P<0.001), and between the IPSS and physiological measures such as peak flow rate (r=— 0.18, P<0.001) and post-void residual urine volume (r= 0.25, P<0.001). There was a very weak correlation between the IPSS and age (r=0.09, P= 0.04).

Conclusions The parameters used to characterize benign prostatic hyperplasia (BPH) should be considered independently because no predictions about the value of a certain parameter can be made by knowing one of the other parameter values. Symptom scores should therefore not be used as a pre-selection criterion in the determination of the prevalence of clinical BPH without taking other measures into account. The interpretation of the parameter values in a clinical setting should take the lack of correlation and the variability of the parameter values into account.

The International Prostate Symptom Score in a community‐based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volume

AUA White Paper on Nonneurogenic Chronic Urinary Retention: Consensus Definition, Treatment Algorithm, and Outcome End Points

OBJECTIVE: To study the long-term outcome of patients undergoing enterocystoplasty. PATIENTS AND METHODS: The study comprised 48 patients (17 men and 31 women; mean age 46 years) who underwent enterocystoplasty for idiopathic detrusor instability (DI, 35 patients) or neurogenic bladder dysfunction (13 patients). Symptoms were scored from 0 to 14 and the overall outcome and generic quality of life were assessed using a Visick grading system (groups A to E) and the Nottingham Health Profile (NHP). These assessments were carried out before, 3 months after operation and at the final follow-up (38 +/- 18 months, range 13-78). Urodynamic studies were performed before and after operation. RESULTS: No patient died after operation and there was minimal early morbidity. Late complications (> 30 days) included incisional hernia (3), anastomotic perforation (1), calculus formation (1) and urethral stricture (1). Clean intermittent self-catheterization (CISC) was performed by 36 (75%) patients. Early symptomatic outcome was good in 40 (83%) patients, moderate in seven (15%) and unsatisfactory in one (2%) patient. The mean symptom scores before and 3 months after surgery were 10 (range 2-14) and 3 (range 2-14), respectively (P < 0.001). There was a significant increase in total bladder capacity (307 +/- 140 to 588 +/- 217 mL; P < 0.001) and bladder compliance (37 +/- 50 to 169 +/- 162 mL/cm H2O; P < 0.001). DI persisted in 15 (31%) patients. NHP scores revealed significant improvements in all domains. Final assessment showed a less satisfactory situation, with recurrent urinary tract infection (UTI) in 17 (37%) patients, a need for long-term antibiotic therapy in seven (15%) and a change in bowel habit in 15 (33%) (13 DI, two with neurogenic bladder dysfunction). CISC was performed by 39 (85%) patients. The long-term outcome was good or moderate in 12 patients (92%) with neurogenic bladder dysfunction and good or moderate in only 19 patients (58%) with DI. CONCLUSION: Clam enterocystoplasty remains an effective management option in some patients with DI, but most patients with neurogenic bladder dysfunction do well. The procedure is, however, associated with long-term complications such as disturbance of bowel habit and recurrent UTIs, which impair the outcome in the long-term in patients with DI despite general improvements in irritative bladder symptoms.

Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction

Noninvasive Methods of Diagnosing Bladder Outlet Obstruction in Men. Part 1: Nonurodynamic Approach

The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints

Two hundred and fifty-three men (age 69.2 +/- 7 years) undergoing prostatectomy for bladder outflow obstruction were studied. The aims were to determine the distribution of voiding pressures and their relationship to presenting symptoms and urodynamic findings. Symptoms were scored by means of a standardised questionnaire and urodynamic studies were performed. Within this study group, high obstructive symptom scores were associated with low flow rates and high urethral resistance. However, high voiding pressures were not associated statistically with low flow rates or obstructive symptoms. Voiding pressures followed a unimodal, parametric distribution and a significant number of men had voiding pressures within the normal range: 9.1% had voiding pressures less than 55 cm H2O and 27.7% less than 75 cm H2O. Irritative symptoms, on the other hand, correlated significantly with obstructive symptoms, high voiding pressures and urethral resistance. Furthermore, high voiding pressures were associated with small cystometric bladder capacities, low compliance and detrusor instability. Whilst these clinical and urodynamic parameters were associated statistically with voiding pressures, none proved specific in being able to identify men with voiding pressures in the high or low end of the range.

Relationship between voiding pressures, symptoms and urodynamic findings in 253 men undergoing prostatectomy.

Dear Editor, Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall prevalence of CMV was 0.67% in their newborn population.1 Among newborns with CMV, it was estimated that 15–20% will suffer from potentially deleterious effects including permanent sensorineural hearing loss, intrauterine 

/pdf/attitude-towards-screening-for-congenital-cytomegalovirus-3tdg589k.pdf

Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore.

1 Department of Otolaryngology, KK Women’s and Children’s Hospital, Singapore 2 Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore 3 Department of Otorhinolarygology-Head & Neck Surgery, Singapore General Hospital, Singapore Correspondence: Dr Ching Yee Chan, Department of Otolaryngology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899. Email: chan.ching.yee@singhealth.com.sg COMMENTARY Ann Acad Med Singap 2022;51:370-2 https://doi.org/10.47102/annals-acadmedsg.2021461

Congenital cytomegalovirus infection: Advocating for screening and education.

OBJECTIVE
This study aimed to investigate the prognostic factors and treatment outcomes in patients with the external auditory canal (EAC) squamous cell carcinoma (SCC).


METHODS
All patients diagnosed with EAC SCC and treated with curative intent at a single tertiary institution were retrospectively reviewed over a 22-year period. Treatment modalities included surgery with adjuvant treatment or definitive radiotherapy. The primary endpoints were overall survival (OS) and disease-specific survival (DSS).


RESULTS
There were 51 patients in our cohort. The 5-year OS and DSS were 64.0% ± 7.0% and 72.0% ± 7.0% respectively. Patients in the surgical arm and RT arm showed no significant difference in OS, DSS, and LRFS (p = 0.075, 0.062, 0.058 respectively). Compared to other routes of spread within the temporal bone, pattern of posterior disease invasion (involving mastoid/sigmoid sinus) showed poorer OS and DSS on multivariate analysis (hazard ratio, HR4.34 and 5.88; p = 0.006 and 0.009). On multivariate analysis, the following factors were independently prognostic of poorer OS and DSS: Previous radiotherapy (HR 3.29 and 4.81, p = 0.021 and p = 0.029); Presence of facial nerve palsy (HR 3.80 and 7.63, p = 0.013 and p = 0.003); Posterior pattern of invasion (HR4.05 and 3.59, p = 0.013 and p = 0.043). Advanced modified Pittsburgh stage was not predictive of poor OS and DSS (HR1.17 and 1.17 E+5, p = 0.786 and p = 0.961).


CONCLUSION
Presence of previous radiotherapy, facial nerve palsy and posterior pattern of disease invasion were independent prognostic factors of poorer survival in patients with EAC SCC.


LEVEL OF EVIDENCE
4 Laryngoscope, 2022.

Analysis of Prognostic Factors For External Auditory Canal Carcinoma: A 22-Year Experience.

Sensorineural hearing loss resulting from microtia and aural atresia is rare due to different embryologic origins of the external and inner ear. Consequently, cochlear implants are seldom performed in patients with microtia and/or aural atresia. Herein we discuss an 8 year-old boy with congenital aural atresia and microtia who underwent cochlear implant surgery for profound hearing loss with good results. A literature review was performed and discussed. Pre-operative planning with high resolution computed tomography and facial nerve monitoring are crucial in identification and preservation of the facial nerve due to the high rate of aberrant anatomy. Careful incision placement is required particularly if pinna reconstruction is considered. Literature review highlighted various surgical approaches as well as different modalities used for intra-operative facial nerve monitoring. Only one patient had intra-operative complications. Cochlear implant is a viable solution in patients with external ear malformations and severe-profound sensorineural hearing loss. Adequate planning and counselling are essential due to the challenges that may occur in microtia and aural atresia.

The role for cochlear implants in microtia and congenital aural atresia: A case report and a review of literature

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