Ureteral stent forgotten for 10 years; a challenge when choices are limited

A 25 - year old man presented with a forgotten left ureteral stent for 10 years. The stent was heavily encrusted particularly at the upper and lower ends with severe hydronephrosis of the kidney. In view of the limited therapeutic options including the endourologic facilities, the patient underwent vesicolithotomy of the lower end of the stent. The residual stent was left for a second step procedure but the patient disappeared. A brief review of the literature for the current international experience of such cases was carried out

Surgical pathology archive of urology in Iraq; where do we stand?

The international surgical centres recognised the progressive importance of archiving the written pathological data as well as the pathological materials such as paraffin blocks and slides using updated techniques to facilitate possible future retrieval of patients' pathological data and research plans. To highlight the difficulties and pitfalls of the current pathological archive of urology in Iraq and demonstrate the characteristics of urology archives in advanced urology centres represented by Torino University [Italy] and Johannes Gutenberg University - Mainz [Germany]. Recommendations are suggested to optimise our surgical pathology archive in general and urology archive in particular in the third millennium. Surgical pathology archive is an essential component of the daily surgical practice and research procedure. In Iraq clear legislation is needed to protect and regulate the surgical pathology archive including that of urology, as well as adequate economic funding to implement new international standards and techniques in this field

Postoperative urological complications of renal transplantation; Al Karama hospital experience

Studying early post kidney transplant urological complication will provide a feed back evaluation for the surgical technique used and the way of complication management. To study the postoperative urological complications and their management in the first 6 months following renal transplantation. This is a retrospective study in which 123 patients with end stage renal disease [ESRD] underwent renal transplantation from January 2001 to October 2004 in Al Karama teaching hospital, Baghdad -Iraq. All the transplanted kidneys were from living donors. Direct matching between the serum of recipient and lymphocytes of the donor was negative. Extravesical ureteroneosystostomy was carried out using a stent across the anastomotic site. Postoperatively recipients were followed for 6 months by clinical and regular laboratory tests. Ultrasound and color Doppler examinations were performed when there was any evidence of decreased urinary output, allograft dysfunction, or clinical suspicion of rejection. In 123 patients aged 5-59 years with a mean age of 34 years, renal transplantation was carried out. Postoperative urological complications within the first 6 months were reported in 12 [9.75%] patients including urinary leakage in 6 [4.8%], ureteral obstruction in 3 [2.4%], and lymphocele in 3 [2.4%] patients. Major urological complications after renal transplantation contribute to patient morbidity and compromise graft function. Early diagnosis and treatment will avoid loss of the graft

Schistosoma - associated bladder cancer in Iraq single center pathologic review

To study the frequency of schistosomiasis in pathologic urinary bladder specimens and the contribution of transitional cell and squamous cell types to the schistosoma - associated and non schistosoma - associated bladder cancer among Iraqi patients. This is a retrospective study in which 1092 pathologic records of 933 patients, who underwent urinary bladder biopsies from bladder tumors or suspicious lesions discovered incidentally during endoscopic evaluation and those who ultimately had radical cystectomy and urinary diversion for invasive bladder cancer, were reviewed in Surgical Specialties Hospital, Baghdad, Iraq between June 2000 and June 2007. In this study 933 patients aged 2-100 years with a mean age of 56.87 +/- 14.3 years. Pathologic review showed schistosomiasis in 81 [8.68%] patients of whom schistosoma associated bladder cancer was reported in 49 [60.5%] patients and schistosomiasis with no pathologic evidence of malignancy in 32 [39.5%] patients. The cell type of schistosoma associated bladder cancer was transitional cell carcinoma [TCC] in 26 [53%], squamous cell carcinoma [SCC] in 19 [38.7%], adenocarcinoma in 1 [2%], and undifferentiated in 3 [6.12%] patients. Out of 852 patients with no pathologic evidence of schistosomiasis, 563 were reported to have non schistosoma associated bladder cancer. The cancer cell type was TCC in 491 [87.21%], SCC in 45 [7.99%], adenocarcinoma in 15 [2.66%], undifferentiated in 11 [1.95%] and sarcoma in 1 [0.18%] patients. Schistosoma associated bladder cancer is still a problem in Iraq as well as other endemic countries. Although the major histological cell type of such cancer in Iraq was SCC, there is a trend for increasing frequency of TCC among patients infected with schistosomiasis

Lower ureteral obstruction and leakage in the first month following renal transplantation

Transplantation has revolutionized treatment of end- stage renal disease [ESRD] by proving more cost effective than hemodialysis, with a lower morbidity and improved quality of life. To evaluate the development of these complications in the first month postoperatively and correlate their development to the type of donation whether related or unrelated. Fifty [50] patients aged [15-62] years, with a mean age [34.46 +/- 12.4 SD] years with [ESRD], who underwent renal transplantation from September 2000 to October 2002, were followed-up for one month postoperatively clinically and by assessment of renal function tests, sonographic and Doppler examinations. Ureteral obstruction was considered in those patients who had allograft dysfunction, ultrasonic evidence of peritransplant collection, moderate-severe dilatation of upper urinary tract of transplanted kidney and postoperative ipsilateral or bilateral leg edema. Ureteral leakage was considered in those patients who had persistent drainage of urine with or without allograft dysfunction. Two patients were excluded from the follow-up due to death in the first 24-hour postoperatively. Six [6] patients [12.5% of cases] developed ureteral obstruction due to peri-ureteral fluid collection. In five patients the collection decreased and upper urinary tract dilatation improved gradually, as shown by ultrasound, on watchful waiting. One patient had surgical evacuation of a large hematoma. Four [4] patients [8.3% of cases] developed ureteral leakage. The leakage stopped in one patient after keeping the urethral catheter for a longer period. Three patients had surgical exploration due to persistent urinary leakage. Redo implantation of allograft ureter was done in two cases. Development of ureteral complications was compared with the type of donation [related or unrelated]. The comparison was not statistically significant. The development of ureteral complications in not related to the type of donation. Extravesical ureteral anastamosis with the use of a stent is less likely to be associated with postoperative ureteral complications

Schistosoma - associated bladder cancer: is there a change in the trend of cell type?

To compare the contribution of squamous cell and transitional cell types to the schistosoma - related and schistosoma - unrelated bladder cancer among Egyptian patients and to evaluate any significant association of carcinoma in situ [CIS] and stage T1 - TCC in schistosomiasis. A retrospective study in which the histopathologic records of 196 patients who underwent radical or salvage cystectomy for bladder cancer from August 1994 to December 2000 in Urology and Nephrology Center/ Mansoura University - Egypt, had been carried out. The age range of patients was [29 - 75] with a mean of [55.82 +/- 8.81] years. Histopathologic examinations of cystectomy specimens showed schistosomiasis in 81[41.32%] patients while in 115 [58.67%] patients; bladder cancer was schistosoma - unrelated. The cell type of cancer in [80] patients with schistosomiasis, was transitional cell carcinoma [TCC] in 40 [50%], squamous cell carcinoma [SCC] in 37 [46.25%], and adenocarcinoma in 3 [3.75%] patients. In schistosoma -unrelated bladder cancer, TCC was reported in 76 [66.08%], SCC in 34 [29.56%], undifferentiated carcinoma in 4 [3.47%] and adenocarcinoma in 1 [0.86%] patients. CIS associated with [stage T1 -TCC] was reported in 2 [15.38%] out of 13 patients with schitosoma - related bladder cancer, while it was reported in 3 [14.28%] out of 21 patients with schistosoma - unrelated bladder cancer. There was no significant statistical difference between the two groups. Schistosoma - related bladder cancer is still a problem in countries endemic with schistsomiasis. Although the major histological cell type in such cancer is SCC, there is a trend of increasing frequency of schistosoma - related TCC

Inconclusive urinary bladder biopsy; facts and lessons

To review the pathologic analysis of urinary bladder biopsies and study the frequency and causes of inconclusive biopsies among Iraqi patients. This is a retrospective study in which 933 patients underwent 1047 urinary bladder biopsy procedures during endoscopic evaluation, or transurethral resection of a known bladder cancer in Surgical Specialties Hospital, Baghdad, Iraq between June 2000 and June 2007. Pathologic records of patients were reviewed. In 933 patients aged 2-100 years with a mean age of 56.87 +/- 14.3 years who underwent 1047 urinary bladder biopsy procedures, pathologic review showed bladder cancer in 655 [62.56%] biopsies, no overt malignancy in 340 [32.47%] biopsies, no pathological diagnosis could be made in 43 [4.11%] biopsies, and nonnal biopsy in 9 [0.86%] biopsies. In 238 bladder cancer biopsies, pathologic analysis of muscle invasion was not carried out due to their lack of muscular tissue. Urinary bladder biopsy is one of the most common biopsies in urology practice. Every effort is made to prevent technical defects of taking and processing such biopsies, to optimize pathologic analysis and surgical management

Transurethral microwave thermotherapy [TUMT] for benign prostatic hyperplasia

Benign prostatic hyperplasia [BPH] is one of the most common diseases of the aging male. Minimally invasive therapies for treatment of BPH compete with the gold standard transurethral resection of the prostate [TURP]. The aim of this study is to assess the efficacy of transurethral microwave therapy [TUMT] in patients with otherwise poor general health. Thirty [30] patients with associated chronic medical diseases and lower urinary tract symptoms due to BPH were subjected for TUMT as an outpatient single session procedure, from June 2001 to August 2005. Follow up was performed 2 weeks, and then one month following treatment clinically and by assessing residual urine volume, maximal flow rate and prostate size. Out of [28] treated patients, [21] were labeled as non - responders as they were unable to pass urine freely 2-weeks after a trial of decatheterisation. In contrast [7] patients passed urine freely after decatheterisation. In the latter group, it was found that there was no statistical significance of the values of maximum flow rate, residual urine volume or prostate size between pre- and one month post TUMT. TUMT is a possible option for the treatment of BPH in poor general health patients or those refusing other surgical modalities. However, it did not prove to be effective for those patients with chronic urinary retention and BPH