Outcome of post-TUR-BT combined chemo and immuno intravesical therapy in the management of papillary transitional cell carcinoma of the urinary bladder

To evaluate the outcome of post-TUR-BT combined chemo-and immune-intravesical therapy in papillary transitional cell carcinoma of the urinary bladder. From Sept 2001 to August 2007 in Alnoor specialist'hospital, Holly Makkah K.S,A and Urology Department, Benha Faculty of Medicine 158 patients of papillary transitional cell carcinoma Ta,T1,T2 were treated by TUR-BT plus combined intravesical chemotherapy and immunotherapy. TUR-BT was repeated and intravesical combined therapy if recurrence occurred on 3, 6 months cystoscopic follow up, percentage of the disease-free patient, recurrence, progression and survival with intact bladder were compared and analyzed. Follow up of the patients up to 5 years was done. At median follow up of about 24 months; 82 patients [53.6%] were disease free and recurrence was detected in 31 patients [20%] and progression was in 4 patients [2.6%]. The results of the follow up at the end of the 5 years revealed that the disease-free percentage was 64 patients [41.5%], recurrence was detected in 41 patients [26.8%] and progression was [14.4%] in 22 patients were shifted to cystectomy. Overall 5 year survival with intact bladder was 85.6% [131 patients], we did not follow cystectomy patients. Post TUR-BT combined intravesical chemo and immuno-therapy is an appropriate option for the management of papillary transitional cell carcinoma of the urinary bladder and could preserve the intact bladder for a long period and should be applied even in muscle invasive T2 tumor before shifting to cystectomy

effect of oral testosterone undecanoate replacement therapy used in treating hypogonadal men on the development of prostate cancer

Objective: To evaluate the effect of oral testosterone undecanoate replacement therapy on the development of prostatic cancer in hypogonadal men of the fifth, sixth, and seventh decades

Patients and Methods: From September 2002 to September 2007, 172 hypogonadal men [44 of the fifth, 60 of the sixth, and 68 of the seventh decade] were treated with oral testosterone undecanoate at the outpatient departments of Urology and Dermatology, Andrology, and Sexually Transmitted Diseases of Alnoor Specialist Hospital, The Holy Makkah, Kingdom of Saudi Arabia. Before starting treatment and every 6 months during the treatment period, all patients underwent routine laboratory investigations in addition to total serum testosterone level. Serum prolactin level was measured only before treatment. They were also evaluated by digital rectal examination [DRE], total prostatic specific antigen [PSA], and transrectal ultrasound [TRUS] of the prostate to exclude prostatic cancer and BPH [with lower urinary tract symptoms, LUTS]. Prostatic biopsy was done in selected cases. Comparative statistical analysis of pretreatment and posttreatment results was done

Results: The mean change of PSA values was insignificant and no patient developed clinical prostatic cancer. However, one patient with evident PSA level change was diagnosed as prostatic intraductal neoplasia [PIN] on prostatic biopsy. In addition, significant prostatic volume mean change of 34.9% +/- 5% was reported. LUTS were encountered in 4 patients

Conclusions: From the current study, it could be concluded that oral testosterone undecanoate replacement therapy does not increase the risk of prostate cancer in selected patients, but may increase prostatic volume or increase the incidence of benign prostatic hyperplasia manifestations

Is extracorporeal shock wave lithotripsy "ESWL" as a monotherapy for renal stones with dilated pelvicalyceal system valuable "experience of 600 patients"

Objective: In this study we try to evaluate the results of ESWL as a mortotherapy for renal stones with dilated pelvicalyceal system and what the percentage of stone free patients after this treatment in comparison with the renal stones in non-dilated system and what the role of other methods of treatment as PCNL and open surgery in the dilated pelvicalyceal system

Patients and Methods: Six hundred patients of renal stone with dilated pelvicatyceal system and two hundred patients of renal stones with relatively non- dilated pelvicalyceal system. All these patients were examined clinically and were candidate for ESWL as a monotherapy for renal stones "randomized" upper, middle, lower calyceal and pelvic stones and variable sizes. The results were compared as stone-free patients 3 months post ESWL. Types of machine and patients were from two centers in Saudi Arabia, all depend on electromagnetic base "Siemen's". Also we evaluated the urinary tract infection associated with ESWL pre and post-management

Results: The result of this study showed a highly significant difference between the two groups as regarding stone size and stone location with increased percentage of stone free patients in the first group [non dilated system] than in the second group "dilated system". Also there increased percentage of stone free patients in PCNL, open surgery and combined ESWL and PCNL than the percentage with ESWL as a monotherapy for renal stones with dilated pelvicalyceal system. The incidence of urinary tract infection was higher in dilated pelvicalyceal system "post ESWL" than ESWL in non-dilated system, PCNL and open surgery

Conclusion: We concluded from this study that ESWL as a monotherapy for renal stones in dilated pelvicalyceal system had decreased percentage of stone-free patients than in non-dilated pelvicalyceal system and this is due to decreased efficiency of pelvicalyceal system in expelling the fragments, and PCNL has a high percentage of stone-free patients if applied alone in dilated system and also in combination with ESWL and open surgery may be needed in many cases and is often preferred for simultaneous stone removal and correction of congenital or pathological obstruction in abnormal pelvicalyceal system

Does urge incontinence contraindicates surgery for stress urinary incontinence?

Urge incontinence is commonly associated with female stress urinary incontinence [SUI]. Many surgeons hesitate to operate for SUI if associated with urgency. Our aim is to define whether urge incontinence contraindicates surgery for SUI or not. This study was conducted on 35 female patients complaining of mixed incontinence [Urge and stress]. Patients with uninhibited detrusor contractions in cystometrogram [CMG] excluded from the study. All patients underwent preoperative assessment by history, physical examination, oblique cystogram, urodynamics [CMG, flowmetry and Valsalva leak point pressure [VLPP]] and cystoscopy. All patients were managed with fascial patch sling either from anterior rectus sheath or fascia lata [in patients with previous suprapubic incision or scarring]. All patients were followed up for one year with the same preoperative parameters. SUI was cured in 34 patients [97.1%] while urge incontinence was cured in 25 patients [71.4%] and persisted in 10 patients [28.6%]. In conclusion, patients complaining of mixed incontinence with urodynamically proved signs of urethral relaxation, as the main component of urge incontinence, will benefit significantly from surgery of SUI

Effect of varicocelectomy on semen parameters in patients with subclinical varicocele

This study was carried out to assess the importance of subclinical grade of varicocele in evaluation of subfertile men. A total of 60 subfertile men with subclinical varicocele diagnosed by scrotal color dupplex ultrasound. Patients were randomly assigned to group I in whom high ligation varicocelectomy was performed and group II who received placebo treatment. Patients were followed up by seminogram at 3 and 6 months. Patients underwent high ligation varicocelectomy Group I showed statistically significant improvement in sperm count after. 3 months and highly statistically significant improvement in sperm count after 6 months. The statistically significant. Improvement in the percentage of abnormal forms was noticed only after 6 months postoperatively. In group II follow up showed non-significant improvement in sperm count, percentage of abnormal forms and grades of sperm motility at either 3 or 6 months. We concluded that the effect of varicocele on semen parameters has no relation to its size and consequently varicocelectomy for subclinical varicocele. diagnosed by color dupplex ultrasound, has benificial effect on semen parameters