BACKGROUND: Over the past decades, the study of the microenvironment of cancer has supported the hypothesis between inflammation and cancer. Previous studies have demonstrated a promising value of platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammatory response in prostate cancer. AIM: To evaluate their pre-biopsy values of PLR and NLR in predicting prostate cancer. MATERIAL AND METHODS: This is a diagnostic study with retrospective design. We included all benign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent prostate biopsy in Adam Malik Hospital between August 2011 and August 2015. We used PSA value above 4 ng/dL as the threshold for the biopsy candidates. The relationship between pre-biopsy variables affecting the percentage of prostate cancer risk was evaluated, including age, prostate-specific antigen (PSA) level, and estimated prostate volume (EPV). The PLR and NLR were calculated from the ratio of related platelets or absolute neutrophil counts with their absolute lymphocyte counts. The values then analysed to evaluate their associations with the diagnosis of BPH and PCa. RESULTS: Out of 298 patients included in this study, we defined two groups consist of 126 (42.3%) BPH and 172 PCa (57.7%) patients. Mean age for both groups are 66.36 ± 7.53 and 67.99 ± 7.48 years old (p = 0.64), respectively. There are statistically significant differences noted from both BPH and PCa groups in terms of PSA (19.28 ± 27.11 ng/dL vs 40.19 ± 49.39 ng/dL), EPV  (49.39 ± 23.51 cc vs 58.10 ± 30.54 cc), PLR (160.27 ± 98.96 vs 169.55 ± 78.07), and NLR (3.57 ± 3.23 vs 4.22 ± 2.59) features of both BPH and PCa groups respectively (p < 0.05). A Receiver Operating Characteristics (ROC) analysis was performed for PLR and NLR in analysing their value in predicting prostate cancer. The Area Under the Curve (AUC) of PLR is 57.9% with a sensitivity of 56.4% and specificity of 55.6% in the cut-off point of 143 (p = 0.02). The NLR cut-off point of 3.08 gives 62.8% AUC with 64.5% sensitivity and 63.5% specificity. These AUCs were comparable with the AUC of PSA alone (68.5%). We performed logistic regression between PSA, PLR, and NLR with result in the exclusion of PLR if calculated conjunctively. Therefore, NLR has a promising performance in predicting PCa in patients with PSA above 4 ng/dL (OR = 3.2; 95% CI: 1.96-5.11). We found as many as 80 (63.5%) patients with benign biopsy results with negative NLR value in this study. CONCLUSION: NLR has promising value in predicting prostate cancer. A further prospective study in validating its diagnostic value was needed.

BACKGROUND: Previous studies demonstrated the promising value of platelet-to-lymphocyte (PLR) in prostate cancer. AIM: This study was conducted to evaluate its pre-biopsy values in predicting prostate cancer. METHODS: We included all benign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent a prostate biopsy in Adam Malik Hospital between August 11th 2011 and August 31st 2015. The relationship between pre-biopsy variables which could be affecting the percentage of prostate cancer risk was evaluated, including age, prostate-specific antigen (PSA) level, and prostate volume (EPV). The PLR was calculated from the ratio of related platelets with their absolute lymphocyte counts. The values then analysed to evaluate their associations with the diagnosis of BPH and PCa. RESULTS: As many as 298 patients consisted of 126 (42.3%) BPH and 172 PCa (57.7%) patients are included in this study. Mean age for both groups are 66.36 ± 7.53 and 67.99 ± 7.48 years old (p = 0.64), respectively. There are statistically significant differences noted from PSA (19.28 ± 27.11 vs 40.19 ± 49.39), EPV (49.39 ± 23.51 vs 58.10 ± 30.54), PLR (160.27 ± 98.96 vs 169.55 ± 78.07), and NLR (3.57 ± 3.23 vs 4.22 ± 2.59) features of both groups (p < 0.05). The AUC of PLR is 57.9% with a sensitivity of 56.4% and specificity of 55.6% in the cut-off point of 143 (p = 0.02). Besides, the NLR cut-off point of 3.08 gives 62.8% AUC with 64.5% sensitivity and 63.5% specificity. We asked for permission from the preceding authors of Indonesian Prostate Cancer Risk Calculator (IPCRC) and calculated its value from 98 randomised patients consist of 45 (45.92%) BPH and 53 (54.08%) PCa. We found a comparable value between PLR/NLR with IPCRC in predicting prostate cancer (AUC of 67.6%, 75.3%, and 68.4%, respectively) with a statistically significant difference of all value in both groups (p < 0.05). CONCLUSIONS: PLR gives promising value in predicting prostate cancer in suspected patients. We suggest a further prospective study to validate its diagnostic values so it can be used as applicable routine calculation.

Introduction: Scrotal lymphedema is a rare condition characterized by the swelling of the scrotal skin due to deterioration in lymphatic drainage. Although not life-threatening, chronic lymphedema is disabling with significant physical and psychological morbidity and complications, including impaired hygiene, urinary incontinence and immobility. This report aimed to describe the diagnosis and treatment of giant scrotal lymphedema. Case Presentation: A 23-year-old man presented with a gradually enlarging scrotum. Physical examination of the genitalia shows that the patient’s penis was difficult to identify, and testes were completely impalpable due to the thickness of the scrotal skin. There were neither inguinal lymph node enlargement nor other skin lesions on the scrotum. The scrotum was homogenous, with a measured dimension of 35 cm x 28 cm x 20 cm anterior to posterior. Laboratory evaluation, including complete blood count, complete metabolic panel, human immunodeficiency virus, sedimentation rate, and antibodies to strongyloides, schistosomes, and filaria, were within normal limits. The penis and testes were normal-sized and clearly demarcated from computed tomography scan, buried within the hardened scrotal soft tissues, with no signs of testicular tumor or any pelvic lymph node enlargement. Conclusion: Scrotal lymphedema is a rare condition characterized by the swelling of the scrotal skin due to deterioration in lymphatic drainage.

Objective: We reported two giant bladder stones cases, with significant comorbidities and mentally impaired patients, treated with PCCL. Case(s) Presentation: We report two cases of giant cystolithiasis (sized 8.8 cm x 7.2 cm and 7.0 cm x 5.8 cm) in male patients with impaired renal functions and mental illness. We performed PCCL on both patients with cystoscopy-guided bladder puncture and dilation, under spinal anesthesia. Stone fragmentation through transurethral (pneumatic) and percutaneous (suprapubic amplatz ultrasound) lithotriptors was performed simultaneously. Discussion: Stone fragments were evacuated through the nephroscope. These fluoroscopy-free procedures were performed under one hour. The patients were discharged on day three post-operatively without indwelling catheter. Conclusion: We performed PCCL with simultaneous transurethral fragmentation in giant bladder stone cases presenting with impaired renal functions and mental illness. We faced no significant post-operative issue. This technique, or its modified approach, is safe and applicable

Introduction: Mirabegron, a b3-adrenoceptor (b3-AR) agonist approved for the treatment of overactive bladder (OAB) symptoms in the adult population, is the first of a new class of compounds with a different mechanism of action. Mirabegron act during the bladder storage phase by relaxing the detrusor muscle thus increase bladder capacity without any significant impact on voiding. Although antimuscarinic agents are commonly used for daytime incontinence associated with overactive bladder and also for patient with congenital cause such as spina bifida, mirabegron could be an effective treatment option in children with neurogenic bladder, as shown in adult populations. In this systematic review, we aimed to evaluate the available literature regarding efficacy and safety of mirabegron in pediatric population. Method: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Result: The symptoms analyzed were frequency, urgency, nocturnal enuresis (NE) and daytime incontinence (DI). 37 (53%) out of 70 children were still receiving treatment at 6 months; 30 received mirabegron monotherapy, and 7 received combination therapy with anticholinergic (Solifenacin n = 4, Desmopressin n = 2, both n = 1). After six months, blood pressure monitoring and ECGs were normal in all patients. For patients on monotherapy, 6 of 17 (35%) had improvement in NE, 11 of 19 (58%) in DI, 12 of 20 (60%) in frequency, and 8 of 21 (38%) in urgency symptoms. For patients receiving combination therapy, 2 of 6 (33%) had improvement in NE, 2 of 4 in DI (50%), 2 of 4 (50%) in frequency, and 4 of 6 (67%) had improvement in urgency. Conclusion: The CV safety of mirabegron, the only clinically available β3-adrenoceptor agonist, appears to be good and comparable with that of antimuscarinic agents, the current first-line therapy for OAB. However, Further long-term data are desirable especially in patients with poorly controlled hypertension, arrhythmia, or cardiac heart failure. Highlights