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Sex: Female
Education:

  • Doctor of Medicine, University of the Philippines Manila
  • University of the Philippines- Philippine General Hospital (Surgery)

Field of Specialization:
Female urology
Health Informatics
Voiding dysfunction

Researches:

Article title: Symptom prevalence, bother, and treatment satisfaction in men with lower urinary tract symptoms in Southeast Asia: a multinational, cross-sectional survey
Authors: Lap‑Yin Ho, Peggy Sau‑KwanChu, David Terrence Consigliere, Zulkifli Md. Zainuddin, David Bolong, Chi‑Kwok Chan, Molly Eng, Dac Nhat Huynh, Wachira Kochakarn, Marie Carmela M. Lapitan, Dinh Khanh Le, Quang Dung Le, Frank Lee, Bannakij Lojanapiwat, Bao‑Ngoc Nguyen, Teng‑Aik Ong, Buenaventura Jose Reyes, Apirak Santingamkun, Woon‑Chau Tsang, Paul Abrams
Publication title: World Journal of Urology 36(6), January 2018

Abstract:
Purpose: The overall objective of the survey was to systematically examine patients' perspectives on lower urinary tract symptoms (LUTS) and their treatment in Southeast Asia. Methods: A multinational cross-sectional survey involving adult men seeking consultation at urology outpatient clinics because of LUTS in Southeast Asia was conducted using convenience sampling. Self-reported prevalence, bother, treatment and treatment satisfaction of selected LUTS including urgency, nocturia, slow stream, and post-micturition dribble were evaluated. Results: In total, 1535 eligible patients were enrolled in the survey. A majority of respondents were aged 56-75 years, not employed, and had not undergone prostate operation before. Overall, the self-reported prevalence of nocturia was 88% (95% CI 86-90%), slow stream 61% (95% CI 59-63%), post micturition dribble 55% (95% CI 52-58%), and urgency 52% (95% CI 49-55%). There were marked differences in the country specific prevalence of LUTS complaints. Frequently, symptoms coexisted and were combined with nocturia. More than half of patients felt at least some degree of bother from their symptoms: 61% for urgency, 57% for nocturia, 58% for slow stream, and 60% for post-micturition dribble. Before seeing the present urologists, nearly half of patients have received some form of prescribed treatment and more than 80% of patients indicated they would like to receive treatment. Conclusion: Men who sought urologist care for LUTS often presented with multiple symptoms. Nocturia emerged as the most common symptom amongst the four core symptoms studied.
Full text link https://tinyurl.com/4wkbn796

Article title: Open retropubic colposuspension for urinary incontinence in women
Authors: Marie Carmela M. Lapitan, June D. Cody, Atefeh Mashayekhi
Publication title: Cohrane Database of Systematic Reviews 7(5), July 2017

Abstract:
Background: Urinary incontinence is a common and potentially debilitating problem. Stress urinary, incontinence as the most common type of incontinence, imposes significant health and economic burdens on society and the women affected. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure to correct stress urinary incontinence.

Objectives: The review aimed to determine the effects of open retropubic colposuspension for the treatment of urinary incontinence in women. A secondary aim was to assess the safety of open retropubic colposuspension in terms of adverse events caused by the procedure. Search methods: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 5 May 2015), and the reference lists of relevant articles. We contacted investigators to locate extra studies.

Selection criteria: Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group.

Data collection and analysis: Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. Main results: This review included 55 trials involving a total of 5417 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.46; 95% CI 0.30 to 0.72 before the first year, RR 0.37; 95% CI 0.27 to 0.51 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 22 trials in comparison with suburethral slings (traditional slings or trans-vaginal tape or transobturator tape) found no overall significant difference in incontinence rates in all time periods evaluated (as assessed subjectively RR 0.90; 95% CI 0.69 to 1.18, within one year of treatment, RR 1.18; 95%CI 1.01 to 1.39 between one and five years, RR 1.11; 95% CI 0.97 to 1.27 at five years and more, and as assessed objectively RR 1.24; 95% CI 0.93 to 1.67 within one year of treatment, RR 1.12; 95% CI 0.82 to 1.54 for one to five years follow up, RR 0.70; 95% CI 0.30 to 1.64 at more than five years). However, subgroup analysis of studies comparing traditional slings and open colposuspension showed better effectiveness with traditional slings in the medium and long term (RR 1.35; 95% CI 1.11 to 1.64 from one to five years follow up, RR 1.19; 95% CI 1.03 to 1.37).In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.56; 95% CI 0.39 to 0.81), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Voiding problems are also more common after sling procedures compared to open colposuspension.

Authors' conclusions: Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of women can expect to be dry. Newer minimal access sling procedures look promising in comparison with open colposuspension but their long-term performance is limited and closer monitoring of their adverse event profile must be carried out. Open colposuspension is associated with a higher risk of pelvic organ prolapse compared to sling operations and anterior colporrhaphy, but with a lower risk of voiding dysfunction compared to traditional sling surgery. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not yet known. A Brief Economic Commentary (BEC) identified five studies suggesting that tension-free vaginal tape (TVT) and laparoscopic colposuspension may be more cost-effective compared with open retropubic colposuspension.
Full text available upon request to the author

Article title: A New Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants: Development and Validation
Authors: Brian S. Buckley, Ph.D., Jacinto Blas Mantaring, M.D., Rodney B. Dofitas, M.D., Marie Carmela Lapitan, M.D., and Aceleen Monteagudo, R.N.
Publication title: Pediatric Dermatology 33(6), September 2016

Abstract:
Background: One methodologic challenge in conducting research relating to diaper dermatitis (DD) is the absence of a reliable, objective, validated scale for assessing severity. The aim of this study was to develop and validate such a scale.

Methods: Scale development was based on experience of DD assessment and clinical and photographic data collected during the early stages of a randomized controlled trial of two DD treatments. The severity score is the sum of scores of four domains: severity of erythema and irritation, area with any DD, papules or pustules, and open skin. Possible scores range from 0 (clear skin) to 6 (extensive DD including intense erythema, papules or pustules, and open skin with damage to the dermis). Assessors used the scale to attribute severity scores using high-definition photographs of infants and babies with DD. Interrater reliability (IRR), internal consistency, and test-retest reliability were considered using intraclass correlation coefficients (ICCs), Cronbach's ?, and Cohen ? statistics.

Results: IRR was very good between assessors familiar with the scale (ICC = 0.949, p < 0.001) and between assessors unfamiliar with the scale (ICC = 0.850, p < 0.001). Test-retest reliability at 2 weeks was good (? = 0.603, p < 0.001). Cronbach's for internal consistency was 0.702. Collation of photographs according to severity score revealed a visible continuum of DD severity, suggesting good construct validity. Conclusion: The newly developed scale appears to be easy to use, reliable, and effective in detecting increasing or lessening DD severity.
Full text link https://tinyurl.com/2p83kpbp

Article title: Benchmarking Anesthesia-Controlled Times at a Tertiary General Hospital in the Philippines
Authors: Patricia Lorna O. Cruz, Emmanuel S. Prudente, Marie Carmela M. Lapitan
Publication title: Acta medica Philippina 49(4):62-68, December 2015

Abstract:
The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself, and the wake up time or time to emergence from anesthesia. Objectives. This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH). Methods. Mean observed times for each of the milestone comprising the ACT were calculated, taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with the length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT. Results. Based on data from 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. This includes times for anesthesia preparation of 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20,15, and 15 mins for inhalational anesthesia; 15, 10, 10 mins for spinal anesthesia; 20, 25,10 mins for epidural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia. Conclusion. It is imperative to standardize ACTs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar setting.
Full text available upon request to the author

Article title: Compliance with international guidelines on antibiotic prophylaxis for elective surgeries at a tertiary-level hospital in the Philippines
Authors: Maria Isabel P. Nabor MD, Brian S. Buckley PhD, arie Carmela M. Lapitan, MD
Publication title: Healthcare infection 20(3-4): 145-151, September - December 2015

Abstract:
Background
Surgical site infections (SSIs) are a major cause of morbidity, associated with extended hospital stays, increasing costs and even death. Perioperative antibiotic prophylaxis has been proven to prevent SSIs. Guidelines have been published to promote best practice but studies continue to highlight poor compliance.

Objective
This study aimed to assess adherence to antibiotic prophylaxis guidelines in common surgical operations in the teaching hospital of the national university in the Philippines.

Methods
This was a medical records-based, cross-sectional study. Common surgical procedures included were breast surgery, enterostomy closure, open and laparoscopic colectomy, and open and laparoscopic cholecystectomy performed from December 2013 to March 2014. Data were extracted relating to patients’ demographic characteristics, types of surgery, prophylactic antibiotic choice, route, dose, timing, redosing and duration of prophylaxis. Observed antibiotic prophylaxis was compared with guidelines.

Results
Of the 244 cases that warranted prophylaxis, 93% were given antibiotics. Of these, 44% conformed with the guideline for type of antibiotic, 39% for dose, 100% for route, 45% for timing, 93% for redosing, and 67% for duration. Only 13% conformed to guidelines for all parameters of prophylaxis. Most cholecystectomies received Cefuroxime, no longer recommended by latest international guidelines. Of the laparoscopic surgeries, 38% received antibiotics earlier than the 1 hour before surgery recommended in latest guidelines.

Conclusions
Ensuring surgeons fully follow guidelines on antibiotic prophylaxis remains a challenge, as highlighted by this study and others conducted around the world. Awareness-raising initiatives might be beneficial at institutional level to improve compliance with best practice guidelines.
Full text available upon request to the author

Article title: Invasive urodynamic studies for the management of lower urinary tract symptoms (LUTS) in men with voiding dysfunction
Authors: Keiran David Clement, Helena Burden, Katherine Warren, Marie Carmela M. Lapitan, Muhammad Imran Omar, Marcus .J Drake
Publication title: Cochrane database of systematic reviews 4(4):CD011179, April 2015

Abstract:
Invasive urodynamic tests are used to investigate men with lower urinary tract symptoms (LUTS) and voiding dysfunction to determine a definitive objective diagnosis. The aim is to help clinicians select the treatment that is most likely to be successful. These investigations are invasive and time-consuming. To determine whether performing invasive urodynamic investigation, as opposed to other methods of diagnosis such as non-invasive urodynamics or clinical history and examination alone, reduces the number of men with continuing symptoms of voiding dysfunction. This goal will be achieved by critically appraising and summarising current evidence from randomised controlled trials related to clinical outcomes and cost-effectiveness. This review is not intended to consider whether urodynamic tests are reliable for making clinical diagnoses, nor whether one type of urodynamic test is better than another for this purpose.The following comparisons were made.• Urodynamics versus clinical management.• One type of urodynamics versus another. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, issue 10), MEDLINE (1 January 1946 to Week 4 October 2014), MEDLINE In-Process and other non-indexed citations (covering 27 November 2014; all searched on 28 November 2014), EMBASE Classic and EMBASE (1 January 2010 to Week 47 2014, searched on 28 November 2014), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (searched on 1 December 2014 and 3 December 2014, respectively), as well as the reference lists of relevant articles. Randomised and quasi-randomised trials comparing clinical outcomes in men who were and were not investigated with the use of invasive urodynamics, or comparing one type of urodynamics against another, were included. Trials were excluded if they did not report clinical outcomes. Three review authors independently assessed trial quality and extracted data. We included two trials, but data were available for only 339 men in one trial, of whom 188 underwent invasive urodynamic studies. We found evidence of risk of bias, such as lack of outcome information for 24 men in one arm of the trial.Statistically significant evidence suggests that the tests did change clinical decision making. Men in the invasive urodynamics arm were more likely to have their management changed than men in the control arm (proportion with change in management 24/188 (13%) vs 0/151 (0%), risk ratio (RR) 39.41, 95% confidence interval (CI) 2.42 to 642.74). However, the quality of the evidence was low.Low-quality evidence indicates that men in the invasive urodynamics group were less likely to undergo surgery as treatment for voiding LUTS (164/188 (87%) vs 151/151 (100%), RR 0.87, 95% CI 0.83 to 0.92).Investigators observed no difference in urine flow rates before and after surgery for LUTS (mean percentage increase in urine flow rate, 140% in invasive urodynamic group vs 149% in immediate surgery group, P value = 0.13). Similarly, they found no differences between groups with regards to International Prostate Symptom Score (IPSS) (mean percentage decrease in IPSS score, 58% in invasive urodynamics group vs 59% in immediate surgery group, P value = 0.22).No evidence was available to demonstrate whether differences in management equated to improved health outcomes, such as relief of symptoms of voiding dysfunction or improved quality of life.No evidence from randomised trials revealed the adverse effects associated with invasive urodynamic studies. Although invasive urodynamic testing did change clinical decision making, we found no evidence to demonstrate whether this led to reduced symptoms of voiding dysfunction after treatment. Larger definitive trials of better quality are needed, in which men are randomly allocated to management based on invasive urodynamic findings or to management based on findings obtained by other diagnostic means. This research will show whether performance of invasive urodynamics results in reduced symptoms of voiding dysfunction after treatment.
Full text available upon request to the author

Article title: Topical petrolatum gel alone versus topical silver sulfadiazine with standard gauze dressings for the treatment of superficial partial thickness burns in adults: A randomized controlled trial
Authors: Glenn Angelo S. Genuino, Kathrina Victoria Baluyut-Angeles, Andre Paolo T. Espiritu, Marie Carmela M. nLapitan, Brian S. Buckley
Publication title: Burns: journal of the International Society for Burn Injuries 40(7), November 2014

Abstract:
Background: Non-extensive superficial partial thickness burns constitute a major proportion of burns. Conventional treatment involves regular changing of absorptive dressings including the application of a topical antimicrobial, commonly silver sulfadiazine. A systematic review has found insufficient evidence to support or refute such antimicrobial prophylaxis. Another review compared silver sulfadiazine dressings with other occlusive and non-antimicrobial dressings and found insufficient evidence to guide practice. Other research has suggested that dressings with petrolatum gel are as effective as silver sulfadiazine.

Methods: Single-center, randomized, controlled parallel group trial comparing conventional silver sulfadiazine dressings with treatment with petrolatum gel alone. Consenting adults 18-45 years old with superficial partial thickness burns≤10% total body surface area seen within 24h of the injury were randomized to daily dressing either with petrolatum gel without top dressings or conventional silver sulfadiazine treatment with gauze dressings. Primary outcomes were blinded assessment of time to complete re-epithelialization, wound infection or allergic contact dermatitis. Secondary outcomes included assessment of ease, time and pain of dressing changes.

Results: 26 patients were randomized to petrolatum and 24 to silver sulfadiazine dressings. Follow up data available for 19 in each group. Mean time to re-epithelialization was 6.2 days (SD 2.8) in the petrolatum group and 7.8 days (SD 2.1) in the silver sulfadiazine group (p=0.050). No wound infection or dermatitis was observed in either group. Scores for adherence to wound, ease of dressing removal and time required to change dressings were significantly better in the petrolatum treatment arm (p<0.01).

Conclusions: Petrolatum gel without top dressings may be at least as effective as silver sulfadiazine gauze dressings with regard to time to re-epithelialization, and incidence of infection and allergic contact dermatitis. Petrolatum gel appears to be an effective, affordable and widely available alternative in the treatment of minor superficial partial thickness burns in adults.
Full text available upon request to the author

Article title: Increased association of the ERG oncoprotein expression in advanced stages of prostate cancer in Filipinos
Authors: Eliza M. Raymundo, Michele H. Diwa, Marie Carmela M. Lapitan, Aladin B. Plaza, Jesus Emmanuel Sevilleja, Shiv Srivastava, Isabell A. Sesterhenn
Publication title: The Prostate 74(11), August 2014

Abstract:
Background: Filipinos with prostate cancer (CaP) are at increased risk of harboring advanced stages and lower survival rates compared to other Asians. This study aims to investigate prevalence of ETS-related gene (ERG) oncoprotein overexpression in Filipinos as surrogate of TMPRSS2-ERG gene fusions, using a highly specific monoclonal antibody (ERG-MAb), and conduct the first attempt to study the role of genetic alterations in the aggressive tumor biologic behaviour of CaP among Filipinos.

Methods: This case-matched, case-control retrospective study evaluated ERG expression in Filipino patients diagnosed with CaP and its effect on stage and Gleason grade of their disease. Men who underwent radical prostatectomy for organ-confined disease at the University of the Philippines-Philippine General Hospital (UP-PGH) comprised the organ-confined cohort. Age-matched adults who had trans-rectal ultrasound-guided prostate (TRUSP) biopsy or trans-urethral resection of the prostate (TURP) with bilateral orchiectomy for T4 or stage IV CaP composed the advanced disease cohort.

Results: Overall ERG expression frequency of 23.08% (N = 104) was demonstrated, with a higher rate observed in the advanced disease cohort (32.69%) compared to the organ-confined group (13.46%). Furthermore, ERG overexpression was only detected among intermediate and high-risk tumors. A high-specificity (98.08%) of the ERG-MAb for malignant prostatic cells was likewise demonstrated.

Conclusions: In contrast to higher ERG frequency in Western countries, it is much lower in Filipino CaP, which is similar to lower rates noted from other Asian countries. The 98.08% specificity of ERG oncoprotein for prostate tumor cells combined with its increased association in advanced disease, suggests for prognostic potential of ERG that may aid clinicians in treatment decisions for Filipino CaP patients.
Full text available upon request to the author

Article title: Invasive urodynamic studies for the management of LUTS in men with voiding dysfunction
Authors: Keiran David Clement, Helena Bevis, Katherine Warren, Marie Carmela M Lapitan, Muhammad Imran Omar, Marcus J Drake
Publication title: Cohrane Database of Systematic Reviews 2014(6), June 2014

Abstract:
This is the protocol for a review and there is no abstract. The objectives are as follows: To determine whether performing invasive urodynamic investigation, as opposed to other methods of diagnosis such as non-invasive urodynamics or clinical history and examination alone, improves the management of LUTS and voiding dysfunction in men. This goal will be achieved by critically appraising and summarising current evidence from randomised controlled trials related to better clinical outcomes and cost-effectiveness. The following hypotheses will be tested. • Do invasive urodynamic investigations improve the clinical outcomes of men with voiding dysfunction? • Do invasive urodynamic investigations alter clinical decision making? • Is one type of invasive urodynamics better than another for improving the outcomes of management of LUTS due to voiding dysfunction and/or for influencing clinical decisions? • Do invasive urodynamic tests identify risk factors for an adverse outcome from surgery? The following comparisons will be made. • Invasive urodynamic tests versus clinical management without invasive urodynamics. • One type of urodynamic test versus another. Because a reference ('gold') standard investigation is not available for comparison, this review will not aim to determine whether invasive urodynamic studies are reliable tests for making a clinical diagnosis, nor whether one type of urodynamic study is better than another for this purpose.
Full text available upon request to the author

Article title: Urodynamic Studies for Management of Urinary Incontinence in Children and Adults: A Short Version Cochrane Systematic Review and Meta-Analysis
Authors: Keiran David Clement, Marie Carmela M. Lapitan, Muhammad Imran Omar, Cathryn Margaret Anne Glazener
Publication title: Neurourology and Urodynamics 34(5), May 2014

Abstract:
Background: Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make an objective diagnosis. The investigations are invasive and time consuming.

Objectives: To determine if treatment according to a urodynamic-based diagnosis, compared to treatment based on history and examination, leads to more effective clinical care and better clinical outcomes.

Search methods: Cochrane Incontinence Group Specialized Register (searched February 19, 2013); reference lists of relevant articles. Selection criteria: Randomized and quasi-randomized trials in people who were and were not investigated using urodynamics, or comparing one type of urodynamic test against another.

Data collection and analysis: At least two independent review authors carried out trial assessment, selection, and data abstraction.

Results: We found eight trials but data were available for only 1,036 women in seven trials. Women undergoing urodynamics were more likely to have their management changed (17% vs. 3%, risk ratio [RR] 5.07, 95% CI 1.87-13.74). Two trials suggested that women were more likely to receive drugs (RR 2.09, 95% CI 1.32-3.31), but, in five trials, women were not more likely to undergo surgery (RR 0.99, 95% CI 0.88-1.12). There was no statistically significant difference in urinary incontinence in women who had urodynamics (37%) compared with those undergoing history and clinical examination alone (36%) (RR 1.02, 95% CI 0.86-1.21).

Authors' conclusions: While urodynamics did change clinical decision-making, there was some high-quality evidence that this did not result in lower urinary incontinence rates after treatment.
Full text available upon request to the author

Article title: Prevalence of Diabetes Mellitus and Metabolic Syndrome in Prostate Cancer Patients given Androgen Deprivation Therapy
Authors: Maria Luisa Cecilia Rivera-Arkoncel, Michael Sagun, Francis Raymond Arkoncel, Cecilia Jimeno, Marie Carmela Lapitan,
Publication title: Journal of the ASEAN Federation of Endocrine Societies 29(1):42-47, May 2014

Abstract:
Objective. To compare the prevalence of diabetes mellitus (DM) and metabolic syndrome (MetS) in prostate cancer patients with or without androgen deprivation therapy (ADT). Methodology. This is a cross-sectional analytic study of prostate cancer patients from the Integrated Surgical Information System database of the Philippine General Hospital from 2004-2010. Patients who received either continuous monthly GnRH agonist injection for at least 6 months or underwent bilateral orchiectomy at least 6 months prior (ADT group) were compared to those who did not (non-ADT group). Patients with DM and MetS were identified using the American Diabetes Association Standards of Medical Care in Diabetes 2010 and IDF Definition of Metabolic Syndrome.

Results. The prevalence of DM in the ADT group is 42% and 19% in the non-ADT group (p = 0.0460). The probability of having DM is 2.17x higher among prostate cancer patients who received ADT compared to those who did not. The prevalence of metabolic syndrome in the ADT and non-ADT group is 37% and 28%, respectively (p=0.4620).

Conclusions. Prostate cancer patients have become an important emerging population of medically at risk older men. Our study showed that the prevalence of DM is significantly higher among the ADT group, with a trend towards greater prevalence of metabolic syndrome in the same group. These men may benefit from closer monitoring for the development of these metabolic complications.
Full text available upon request to the author

Article title: 2013 Annual National Digital Rectal Exam Day: impact on prostate health awareness and disease detection
Authors: Michael E. Chua, Marie Carmela M. Lapitana, Marcelino L. Morales Jr., Aristotle Bernard Maniego Roque, John Kenneth Domingo, Philippine Urological Residents Association (PURA)
Publication title: Prostate International 2(1):31-6, March 2014

Abstract:
"Mag-paDRE" is a yearly prostate health public awareness program initiated by the Philippine Urological Association. This study aimed to describe the demographic and clinical data of the participants in the 2013 "Mag-paDRE" program and to identify factors that will further improve prostate health public awareness. A descriptive cross-sectional study undertaken to collect and assess the demographic data, International Prostate Symptom Score (IPSS) and digital rectal examination findings of the participants in the "Mag-paDRE" conducted in the 10 Philippine Board of Urology (PBU) different accredited training institutions. Descriptive statistics was used to report the proportion of Filipino men aged 40 or older who presented for their first prostate health evaluation. Clinical profile were reviewed and summarized. The study protocol was registered in the Clinicaltrial.gov under Identifier NCT01886547. A total of 925 participants from the 10 PBU accredited training institutions were assessed. Among the 10 training institutions the large tertiary government owned medical center had the highest number of participants and target participants recruited; while the private sectors owned tertiary hospitals have the highest proportion of target participants and cases. According to the predetermined definition of this study, 614 (66%) were considered the target population for the "Mag-paDRE" program. The mean age of the target participants was 58.9±9.9. Only 360 of 614 (59%) were new case, 118 (32.7%) had severe lower urinary tract symptoms (LUTS), 223 (62%) had moderate LUTS, 19 (5.3%) were asymptomatic but with hard prostates, palpable prostate nodules or prostate tenderness. The most bothersome symptoms were incomplete bladder emptying (30.2%), and frequency (22.9%). Overall, the 2013 "Mag-paDRE" among the 10 training institutions was effective in promoting prostate health awareness. A need to modify the preactivity information dissemination by these institutions can be done to further increase the attendance of targeted population of the prostate health awareness program.
Full text available upon request to the author

Article title: Efficiency Status of the Elective Non-Cardiac Surgery Operating Rooms of the Department of Surgery of the Philippine General Hospital
Authors: Marie Carmela M. Lapitan, Brian S. Buckley, Donna D. Abalajon, Patricia Lorna O. Cruz, Maria Eliza M. Raymundo
Publication title: Acta medica Philippina 47(4):30-35, December 2013

Abstract:
Introduction. The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR efficiency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.

Objectives. This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.

Methods: A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.

Results: Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.

Conclusions. The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.
Full text available upon request to the author

Article title: Nutritional Assessment of Adult Cancer Patients admitted at the Philippine General Hospital using the Scored Patient Generated Subjective Global Assessment Tool (PG-SGA)
Authors: Carmela Isabel A. Caballero, Marie Carmela M. Lapitan, Brian S. Buckley

Publication title: Acta medica Philippina 47(4), December 2013

Abstract:
No available
Full text link https://tinyurl.com/ye226ncj

Article title: Urodynamic studies for management of urinary incontinence in children and adults
Authors: Keiran David Clement, Marie Carmela M. Lapitan, Muhammad Imran Omar, Cathryn M.A. Glazener
Publication title: Cochrane database of systematic reviews 10(10):CD003195, October 2013

Abstract:
Background: Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive, objective diagnosis. The aim is to help select the treatment most likely to be successful. The investigations are invasive and time consuming.

Objectives: The objective of this review was to determine if treatment according to a urodynamic-based diagnosis, compared to treatment based on history and examination, led to more effective clinical care of people with urinary incontinence and better clinical outcomes.The intention was to test the following hypotheses in predefined subgroups of people with incontinence:(i) urodynamic investigations improve the clinical outcomes;(ii) urodynamic investigations alter clinical decision making;(iii) one type of urodynamic test is better than another in improving the outcomes of management of incontinence or influencing clinical decisions, or both. Search methods: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In-Process, handsearching of journals and conference proceedings (searched 19 February 2013), and the reference lists of relevant articles.

Selection criteria: Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamic test against another were included. Trials were excluded if they did not report clinical outcomes.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. Main results: Eight trials involving around 1100 people were included but data were only available for 1036 women in seven trials, of whom 526 received urodynamics. There was some evidence of risk of bias. The four deaths and 12 dropouts in the control arm of one trial were unexplained.There was significant evidence that the tests did change clinical decision making. Women in the urodynamic arms of three trials were more likely to have their management changed (proportion with change in management compared with the control arm 17% versus 3%, risk ratio (RR) 5.07, 95% CI 1.87 to 13.74), although there was statistical heterogeneity. There was evidence from two trials that women treated after urodynamic investigations were more likely to receive drugs (RR 2.09, 95% CI 1.32 to 3.31). On the other hand, in five trials women undergoing treatment following urodynamic investigation were not more likely to undergo surgery (RR 0.99, 95% CI 0.88 to 1.12).There was no statistically significant difference however in the number of women with urinary incontinence if they received treatment guided by urodynamics (37%) compared with those whose treatment was based on history and clinical findings alone (36%) (for example, RR for the number with incontinence after the first year 1.02, 95% CI 0.86 to 1.21). It was calculated that the number of women needed to treat was 100 women (95% CI 86 to 114 women) undergoing urodynamics to prevent one extra individual being incontinent at one year.One trial reported adverse effects and no significant difference was found (RR 1.10, 95% CI 0.81 to 1.50). Authors' conclusions: While urodynamic tests did change clinical decision making, there was some evidence that this did not result in better outcomes in terms of a difference in urinary incontinence rates after treatment. There was no evidence about their use in men, children, or people with neurological diseases. Larger definitive trials are needed in which people are randomly allocated to management according to urodynamic findings or to management based on history and clinical examination to determine if performance of urodynamics results in higher continence rates after treatment.
Full text available upon request to the author

Article title: Drugs for the prevention of postoperative urinary retention in adults
Authors: Marie Carmela M Lapitan, Brian S. Buckley, Roy Lascano, Mark Joseph Abalajon
Publication title: Cohrane Database of Systematic Reviews 2013(10), October 2013

Abstract:
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To make the following comparisons involving drugs for the prevention of postoperative urinary retention in adults, in terms of their effectiveness and harm: one drug or drug type versus placebo or no treatment; one drug or drug type versus another drug or drug type; different dosages and timings of administration of the drug.
Full text available upon request to the author

Article title: Nutritional assessment of adult cancer patients admitted at the philippine general hospital using the scored patient generated subjective global assessment tool (PG-SGA)
Authors: C. I. A.Caballero, M. C. M. Lapitan, B. S. Buckley
Publication title: Clinical Nutrition Supplements 7(1):186-187, September 2012

Abstract:
Malnutrition is common among cancer patients. The aim of this study was to determine the nutritional status of preoperative cancer patients upon admission at a tertiary hospital in the Philippines. It also aimed to identify common symptoms with adverse impact on nutrition and to correlate the nutritional status to the length of hospital stay and development of post-operative complications. Methods: A hospital-based prospective cohort study design was conducted among pre-operative adult cancer patients admitted from September to December 2010. Nutritional status assessment was done using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) tool and correlation to their symptoms, length of hospital stay, and post-operative complications were determined using analysis of variance (ANOVA) and Chi-Square tests. Result. A total of 103 patients were included for the study amongst whom prevalence of malnutrition was 83%. Symptoms that were significantly associated with severity of malnutrition were early satiety, lack of appetite and alteration in taste perception. Poor nutritional status was associated with increased mean length of hospital stay: 7.5, 14.1 and 15.1 days for well-nourished, moderately malnourished and severely malnourished, respectively (p = 0.048). Conclusion: Using the Scored PG-SGA tool, this study observed a correlation between severity of nutritional status and increased length of hospital stay among cancer patients. Presence of nutritional impact symptoms such as lack of appetite, early satiety, and alteration of taste perception correlated with the degree of malnutrition on admission.Recommendations. Formal objective assessment of the nutritional status of cancer patients should be done. Addressing the symptoms of lack of appetite, early satiety, and alteration of taste perception should be prioritized to prevent deterioration in nutrition.
Full text available upon request to the author

Article title: Systematic Review of Perioperative and Quality-of-life Outcomes Following Surgical Management of Localised Renal Cancer
Authors: Steven MacLennan, Mari Imamura, Marie C. Lapitan, Muhammad Imran Omar, Thomas B. L. Lam, Ana M. Hilvano-Cabungcal, Pam Royle, Fiona Stewart, Graeme MacLennan, Sara J. MacLennan, Philipp Dahm, Steven E. Canfield, Sam McClinton, T. R. Leyshon Griffiths, Börje Ljungberg, JamesN’Dow
Publication title: European Urology 62(6), July 2012

Abstract:
Context
For the treatment of localised renal cell carcinoma (RCC), uncertainties remain over the perioperative and quality-of-life (QoL) outcomes for the many different surgical techniques and approaches of nephrectomy. Controversy also remains on whether newer minimally invasive nephron-sparing interventions offer better QoL and perioperative outcomes, and whether adrenalectomy and lymphadenectomy should be performed simultaneously with nephrectomy. These non-oncological outcomes are important because they may have a considerable impact on localised RCC treatment decision making.

Objective
To review systematically all the relevant published literature comparing perioperative and QoL outcomes of surgical management of localised RCC (T1–2N0M0).

Evidence acquisition
Relevant databases including Medline, Embase, and the Cochrane Library were searched up to January 2012. Randomised controlled trials (RCTs) or quasi-randomised controlled trials, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The outcome measures were QoL, analgesic requirement, length of hospital stay, time to normal activity level, surgical morbidity and complications, ischaemia time, renal function, blood loss, length of operation, need for blood transfusion, and perioperative mortality. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation.

Evidence synthesis
A total of 4580 abstracts and 380 full-text articles were assessed, and 29 studies met the inclusion criteria (7 RCTs and 22 NRSs). There were high risks of bias and low-quality evidence for studies meeting the inclusion criteria. There is good evidence indicating that partial nephrectomy results in better preservation of renal function and better QoL outcomes than radical nephrectomy regardless of technique or approach. Regarding radical nephrectomy, the laparoscopic approach has better perioperative outcomes than the open approach, and there is no evidence of a difference between the transperitoneal and retroperitoneal approaches. Alternatives to standard laparoscopic radical nephrectomy (LRN) such as hand-assisted, robot-assisted, or single-port techniques appear to have similar perioperative outcomes. There is no good evidence to suggest that minimally invasive procedures such as cryotherapy or radiofrequency ablation have superior perioperative or QoL outcomes to nephrectomy. Regarding concomitant lymphadenectomy during nephrectomy, there were low event rates for complications, and no definitive difference was observed. There was no evidence to base statements about concomitant ipsilateral adrenalectomy during nephrectomy.

Conclusions
Partial nephrectomy results in significantly better preservation of renal function over radical nephrectomy. For tumours where partial nephrectomy is not technically feasible, there is no evidence that alternative procedures or techniques are better than LRN in terms of perioperative or QoL outcomes. In making treatment decisions, perioperative and QoL outcomes should be considered in conjunction with oncological outcomes. Overall, there was a paucity of data regarding QoL outcomes, and when reported, both QoL and perioperative outcomes were inconsistently defined, measured, or reported. The current evidence base has major limitations due to studies of low methodological quality marked by high risks of bias.
Full text available upon request to the author

Article title: Corrigendum to “Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer” [Eur Urol 2012;61:972–93]
Authors: Steven MacLennan, Mari Imamura, Marie C. Lapitan, Muhammad Imran Omar, Thomas B. L. Lam, Ana M. Hilvano-Cabungcal, Pam Royle, Fiona Stewart, Graeme MacLennan, Sara J. MacLennan, Philipp Dahm, Steven E. Canfield, Sam McClinton, T. R. Leyshon Griffiths, Börje Ljungberg, JamesN’Dow
Publication title: European Urology 62(1):193, July 2012

Abstract:
No available
Full text available upon request to the author

Article title: Open retropubic colposuspension for urinary incontinence in women
Authors: Marie Carmela M Lapitan, June D. Cody
Publication title: Cochrane database of systematic reviews 6(6):CD002912, June 2012

Abstract:
Background: Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure.

Objectives: To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence.

Search methods: We searched the Cochrane Incontinence Group Specialised Register (searched 13 March 2012), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted investigators to locate extra studies. Selection criteria: Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group.

Data collection and analysis: Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. Main results: This review included 53 trials involving a total of 5244 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 20 trials in comparison with suburethral slings (trans-vaginal tape or transobturator tape) found no significant difference in incontinence rates in all time periods assessed.In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' conclusions: Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension-free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not known yet.
Full text available upon request to the author

Article title: The effect of urinary incontinence on health utility and health-related quality of life in men following prostate surgery
Authors: Brian S. Buckley, M.C.M. Lapitan, C.M. Glazener,
Publication title: Neurourology and Urodynamics 31(4):465-9, April 2012

Abstract:
The impact of urinary incontinence (UI) on health-related quality of life (HRQoL) has been less well researched in men than women and the general population. This study aims to assess the association between UI and HRQoL in men 1 year after prostate surgery. Planned secondary analysis of data from two parallel randomized controlled trials of active conservative treatment for UI in 853 men following radical prostatectomy (RP) and transurethral resection of the prostate (TURP). Men of any age were eligible for trial inclusion if they were experiencing UI 6 weeks after undergoing RP or TURP at 34 centers in the United Kingdom. Univariate and multivariate analysis considered associations between health status (SF-12 and EQ-5D) and self-reported UI. Multivariate analysis controlled for age, obesity, UI prior to surgery, and concomitant fecal incontinence. Mean age of 411 men in the RP trial was 62.3 years (SD 5.7) and 442 men in the TURP trial was 68.0 (SD 7.9). Of men with UI at 6 weeks after surgery, 76.7% in the RP group and 63.2% in the TURP group still had UI at 12 months. Any UI at 12 months was significantly associated with reduced HRQoL in the RP group and lower EQ-5D and SF-12 Mental Component Scores in the TURP group. Any UI is a significant factor in reduced HRQoL in men following prostate surgery, particularly younger men who undergo RP. Its importance to patients as an adverse outcome should not be underestimated.
Full text available upon request to the author

Article title: Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer
Authors: Steven MacLennan, Mari Imamura, Marie C. Lapitan, Muhammad Imran Omar, Thomas B. L. Lam, Ana M. Hilvano-Cabungcal, Pam Royle, Fiona Stewart, Graeme MacLennan, Sara J. MacLennan, Philipp Dahm, Steven E. Canfield, Sam McClinton, T. R. Leyshon Griffiths, Börje Ljungberg, JamesN’Dow
Publication title: European Urology 61(5):972-93, February 2012

Abstract:
Context
Renal cell carcinoma (RCC) accounts for 2–3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC.

Objective
Systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1–2N0M0).

Evidence acquisition
Relevant databases including Medline, Embase, and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence, and metastases. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies (NRSs). The quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Evidence synthesis
A total of 4580 abstracts and 389 full-text articles were assessed. Thirty-four studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low-quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together, the evidence showed improved survival for partial nephrectomy for tumours ≤4 cm. The overall evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved.

Conclusions
The evidence base suggests localised RCCs are best managed by nephron-sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.
Full text available upon request to the author

Article title: Urodynamic studies for management of urinary incontinence in children and adults
Authors: Cathryn M.A. Glazener, Marie Carmela M. Lapitan
Publication title: Cochrane database of systematic reviews 1(1):CD003195, January 2012

Abstract:
Background: Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive objective diagnosis. The aim is to help to select the treatment most likely to be successful. The investigations are invasive and time consuming.

Objectives: The objective of this review was to discover if treatment according to a urodynamic-based diagnosis, compared to treatment based on history and examination, led to more effective clinical care of urinary incontinence and better clinical outcomes. Search methods: We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings (searched 24 May 2011), and the reference lists of relevant articles.

Selection criteria: Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamics against another. Trials were excluded if they did not report clinical outcomes.

Data collection and analysis: Two reviewers independently assessed trial quality and extracted data.

Main results: Seven small trials involving around 400 people were included but data were only available for 385 women in five trials, of whom 197 received urodynamics. There was some evidence of risk of bias. The four deaths and 12 dropouts in the control arm of one trial were unexplained.There was some evidence that the tests did change clinical decision making. There was evidence from two trials that women treated after urodynamic investigations were more likely to receive drugs (RR 2.09, 95% CI 1.32 to 3.31) but not, in three trials, surgery (RR 1.75, 95% CI 0.39 to 7.75). Women in the urodynamic arms of two trials were more likely to have their management changed but this did not quite reach statistical significance (proportion with no change in management 76% versus 99%, RR 0.79, 95% CI 0.57 to 1.10).However, there was not enough evidence to demonstrate whether or not this resulted in a clinical benefit. For example there was no statistically significant difference in the number of women with urinary incontinence if they received treatment guided by urodynamics (70%) versus those whose treatment was based on history and clinical findings alone (62%) (e.g. RR for number with incontinence after first year 1.23, 95% CI 0.60 to 2.55).No trials reported whether or not there were any adverse effects.

Authors' conclusions: While urodynamic tests may change clinical decision making, there was not enough evidence to suggest whether this would result in better clinical outcomes. There was no evidence abut their use in men, children or people with neurological diseases. Larger definitive trials are needed, in which people are randomly allocated to management according to urodynamic findings or to standard management based on history and clinical examination.
Full text available upon request to the author