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Introduction: International prostate symptom score is a validated questionnaire used to evaluate the lower urinary tract symptoms in benign prostatic hyperplasia. Visual prostate symptom score is a new simplified symptom score with pictograms to evaluate the same. We evaluated the correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms.Methods: Male patients aged ≥40 years attending the Urology clinic were enrolled in the study. They were given international prostate symptom score and visual prostate symptom score questionnaires to complete providing assistance whenever needed. Demographic data, examination findings and uroflowmetry parameters were noted. Correlation and regression analysis was used to identify correlation of the two scoring systems and uroflowmetry parameters.Results: Among the 66 patients enrolled, only 10 (15.15%) patients were able to understand English language. There was a statistically significant correlation between total visual prostate symptom score and international prostate symptom score (r= 0.822; p<0.01). The correlations between individual scores of the two scoring systems related to force of urinary stream, frequency, nocturia and quality of life were also statistically significant. There was also a statistically significant correlation of both scores with maximum flow rate and average flow rate.Conclusions: There is a statistically significant correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters. IPSS can be replaced with simple VPSS in evaluation of lower urinary tract symptoms in elderly male patients.Keywords: correlation; international prostate symptom score; lower urinary tract symptoms; uroflowmetry; visual prostate symptom score. [PubMed]

Aim: To evaluate the efficacy of intramuscular injection of 75 mg diclofenac sodium and periprostatic nerve block (PPNB) with 1% lignocaine in controlling pain during transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and Methods: A total of 120 patients undergoing TRUS-guided prostate biopsies were prospectively enrolled in the study. First, 20 patients did not get any form of analgesia/anesthesia and served as control; next, 20 patients received an intramuscular injection of diclofenac sodium. PPNB with 1% lignocaine was performed in the remaining 80 patients. Pain was assessed using Wong-Baker Faces Pain-Rating Scale (0–10). Results: All three groups of patients were comparable at baseline in terms of age, prostate-specific antigen and final histological diagnosis. The mean pain scores (±SD) for control, diclofenac and PPNB groups were 5.10 ± 3.14, 3.70 ± 2.36 and 2.24 ± 1.63, respectively. The difference was statistically significant between control and PPNB (p = 0.001), and diclofenac and PPNB (p = 0.002), but not between the control and diclofenac group (p = 0.120). In addition, the proportion of patients having mild or no pain (defined as pain score ≤3) during the biopsy was greater in the PPNB group (71%) compared with the diclofenac group (45%) and the control group (30%) (p = 0.001). The total duration for TRUS biopsy was not significantly different between the three groups (p = 0.114). Conclusion: PPNB with 1% lignocaine significantly decreases pain associated with prostate biopsy when compared with control and intramuscular diclofenac.

Lower urinary tract symptoms (LUTS) are mostly due to benign prostate hyperplasia (BPH) in the elderly men. The severity of LUTS associated with BPH is measured with the international prostate symptom score (IPSS). Objective indicators of the disease severity in BPH are prostate volume, post void residual urine volume (PVRU), uroflowmetry values etc. However the correlation between the severity of subjective symptoms and objective parameters remains unclear. We designed this study to see if there actually is a correlation between the subjective symptoms and the objective parameters in evaluation of LUTS. Elderly male patients presenting with LUTS in the Urology OPD over a period of 10 months are enrolled in this study. These patients are asked to fill the IPSS with assistance if necessary from medical person. Prostate volume and PVRU are measured with trans-abdominal ultrasonography. Uroflowmetry evaluations are done to record maximum flow rate (Qmax) and average flow rate (Qave). Correlation of IPSS with age, prostate volume, PVRU and uroflowmetry parameters is evaluated using correlation regression analysis. Our results revealed significant positive correlation of IPSS with prostate volume and PVRU. Similarly there is significant negative correlation of IPSS with Qmax and Qave. Hence this study concluded that there is significant correlation between symptom severity and objective parameters in elderly patients with LUTS.

Introduction and Importance: Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition to that, the calculus discussed in this case report was of a very large size and was removed intact. Open pyelolithotomy, the procedure used, is one that comes with a wide range of complications but can be deemed effective in certain cases. In this scenario, it led to no impediments to normal physiology. Case Presentation: Here the authors report the case of a 45-years-old Nepalese male who presented with a large yet asymptomatic staghorn calculus. It was managed with an open pyelolithotomy, and the patient had no intraoperative or postoperative complications. Discussion: Staghorn stones can be complete or partial and often naturally progress to renal impairment. Thus, an aggressive therapeutic approach is crucial, with careful evaluation of the site and size of the stone, the patient’s preference, and the institutional capacity. Ideally, staghorn calculi are completely removed, and it is imperative that the functions of the affected kidney are preserved as far as possible and when applicable. Although percutaneous nephrolithotomy is recommended for the removal of staghorn stones, several clinical, technical, and socioeconomic factors contributed to the use of open pyelolithotomy in the management of the case discussed here. Conclusion: Open pyelolithotomy can prove highly effective in removing large stones intact and in a single setting, the importance of which was accentuated by its unique clinical presentation and pathological anomalies.