Achilles Tendon Measurements in Asymptomatic Saudi Adults Using High-frequency Ultrasound

ABSTRACT Objective: To measure the Achilles tendon length, thickness and cross-sectional area in asymptomatic adult Saudi participants and to investigate the possible changes in these measurements based on their different ages and body height. Methods: The prospective cohort study was done between January 2014 and March 2015. A total of 200 asymptomatic participants with 175 males (87.5%) and 25 females (12.5%) between the ages of 14 and 65 years, with the mean age of 25 ± 1.5 years, were scanned at two radiology departments. Ultrasound (US) scans for the Achilles tendons were performed using a Hitachi (EZU-MT30-S1 HI Vision Avius, Hitachi, Japan) US machine. Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) was used to analyse the results. Results: There was no significant difference in the length, cross-sectional area and thickness of the Achilles tendons among the participants of different ages; however, the cross-sectional area of Achilles tendons of the older participants (≥ 47 years) was higher than that of the participants of the younger age groups. Moreover, there was no correlation between the length, cross-sectional area, and thickness of the Achilles tendons and their body heights; however, the participants of ≥ 153 cm in height showed an increase in their Achilles tendon cross-sectional areas. Conclusion: Ultrasound is a useful imaging tool in the assessment of the Achilles tendons. The normal variations of the tendon morphological characteristics should be considered in the clinical diagnosis. Additional studies on the correlations among the Achilles tendon length, thickness and cross-sectional areas of ethnicity of the participants in Saudi Arabia are suggested.

Robotic or open radical prostatectomy after previous open surgery in the pelvic region

PURPOSE: We sought to evaluate the feasibility and safety of open or robotic radical prostatectomy (RP) after rectum, sigmoid, or colon surgery. MATERIALS AND METHODS: Sixty-four patients with a median age of 65 years (range, 46-73 years) who underwent RP after previous pelvic surgery were included. Twenty-four patients (38%) underwent robotic RP and 40 patients (62%) underwent open RP. Bilateral lymph node dissection and nerve preservation were performed in 50 patients (78%) and 35 patients (55%), respectively. Variables evaluated included demographic characteristics, perioperative complications, and functional and oncological outcomes. The median hospitalization and follow-up periods were 2 days (range, 1-12 days) and 21 months (range, 1-108 months), respectively. RESULTS: No conversions from robotic to open surgery were performed and there were no intraoperative complications. Surgical margins were positive in 13 patients (20%), seminal vesicle involvement was detected in 6 patients (9%), and lymph node involvement was found in 2 patients (3%). Postoperative complications included lymphocele in 1 patient, urethral stricture in 1 patient, and bowel obstruction and persistent bladder leakage in 2 patients. Eighty-eight percent of the patients were continent at 7 months and 80% of patients were able to achieve erection with or without medical aid. CONCLUSIONS: Open or robotic RP can be done safely and effectively in patients who have previously undergone pelvic surgery. Although prior pelvic surgery of the large intestine was associated with increased morbidity, it should not be considered a contraindication for robotic or open RP.

Is There an Association Between Serum Prostate-Specific Antigen Values and Serum Testosterone Levels in Healthy Men?

PURPOSE: To evaluate the relationship between levels of total testosterone and total prostate-specific antigen (PSA) in healthy men with PSA or =50 years. RESULTS: In all patients, the mean values for serum PSA and total testosterone were 1.27+/-0.88 ng/mL and 404.04+/-158.86 ng/mL, respectively. No correlation was detected between serum PSA and testosterone levels in either subgroup (group I, r=0.072, p=0.363; group II, r=0.031, p=0.900) or in patients aged or =50 years and in patients aged <50 years were 417.01+/-163.35 and 344.16+/-120.21 ng/dL, respectively (p=0.02). CONCLUSIONS: No impact of testosterone was found on the PSA level in healthy men with PSA <4 ng/mL. Therefore, a high serum testosterone level may not mandate adjustment of PSA values. This serum sex hormone showed a significant increment after the age of 50 years. Further studies including a larger number of patients should be carried out to confirm these findings.

Laparoscopic assisted percutaneous nephrolithotomy for renal pelvis stone in a crossed fused ectopic kidney: a case report

Crossed Renal Ectopia [CRE] is a relatively rare congenital renal anomaly. Management of stones formed within such anomalous renal architecture is a challenge for urological surgeons especially in the fused form of the anomaly [CFRE]. There is an increasing trend for using percutaneous nephrolithotomy [PCNL] in such complicated cases. However, certain anatomical variants of this anomaly will make PCNL technically difficult especially when the path to the diseased kidney is blocked by the normal one. In this clinical report, we present a case of renal pelvis stone in a CFRE patient whose target pelvis position was technically difficult to reach by the fluoroscopy guided PCNL technique alone. To circumvent this difficulty, we successfully made use of the laparoscopic technology to visually navigate our way while creating the tract for the PCNL scope sheath in to the target renal pelvis

How to Achieve Long-Term Success in the Treatment of Female Urinary Stress Incontinence? Novel Modification on Vaginal Sling

PURPOSE: Modest long-term success is one of the most disappointing issues facing patients undergoing anti-incontinence surgery. Herein we introduce a novel surgical modification of the vaginal sling to address the mechanisms that may lead to a reduction in the success rate at the long-term follow-up. MATERIALS AND METHODS: Twenty-three female patients with mean age of 48.2 years (range, 22-73 years) underwent anti-incontinence surgery to correct their stress urinary incontinence (SUI) between August 2006 and January 2008. The in situ anterior vaginal wall sling, reinforced with equi-size monofilament polypropylene tape, was used as an anti-incontinence surgical procedure. The mean follow-up period was 30.2 months (range, 24-38 months). RESULTS: The surgical technique was successful in 22 patients (95.65%); 20 of them were cured and 2 patients showed clinical improvements. Urinary retention was observed in one patient (4.34%), which was resolved after decreasing the tension of the suspension sutures. No significant post-voiding residue was detected postoperatively. CONCLUSIONS: Cost-effectiveness and a low risk of urethral erosion, due to the presence of intervening vaginal mucosa, are important advantages of this technique. Long-term success is expected, because relaxation of the non-tension-free suspension sutures and dislocation of the midurethral sling are less likely.

In situ anterior vaginal wall sling for treatment of stress urinary incontinence extended application and further experience

Our aim was to evaluate the efficacy of utilizing in situ anterior vaginal wall sling in the treatment of stress urinary incontinence [SUI]. The study included 11 women with a median age of 50 years [range, 36 to 60 years] who were operated on during the period of November 2005 to August 2006. They were diagnosed with SUI and were operated on using placard-shaped in situ anterior vaginal wall sling technique. Nine patients underwent surgical treatment for the first time, while 2 patients had postoperative recurrent SUI. In all of the patients, urethral hypermobility with or without cytocele was observed. The mean follow-up period was 22.5 months [range, 17 to 28 months]. Ten patients [90.9%] were considered cured and 1 [9.1%] started leakage of urine after 1 month during the postoperative period. One patient [9.1%] had urinary retention. Three patients [27.3%] had evidence of wound infection which was treated by appropriate oral medical therapy. In situ anterior vaginal wall sling technique is accredited with a good success rate and low incidence of complications. It is easy to learn and cost-effective, making it a suitable technique for SUI. Longer follow-up and larger number of patients are needed before final conclusion could be drawn

Shoulder distension during arthrography with intraarticular corticosteroid injection versus suprascapular nerve block in treatment of frozen shoulder

To evaluate and compare the effectiveness of therapeutic shoulder distension during arthrography with intraarticular steroid injection and suprascapular nerve block [SSNB], to relieve pain and improve the range of movement [ROM] of the shoulder joint, in patients with frozen shoulder. Forty patients presenting with idiopathic frozen shoulder, as proved after full history taking and thorough clinical examination, were randomly classified into two groups [20 each]. The first group was treated with therapeutic shoulder distension during arthrography with intraarticular steroid injection, while the second group was treated with suprascapular nerve block. All patients were subjected to the same therapeutic exercises program for 4 weeks. The patients were evaluated at baseline, 1week, 4 weeks and 12 weeks, to assess the degree of improvement. Parameters of evaluation were pain intensity [rest and movement pain], tenderness severity, ROM [active and passive] of shoulder joint and subjective evaluation of improvement. In both groups, there was a highly significant [p<0.001] improvement of pain and tenderness as compared with baseline, which was maintained up to 12 weeks. SSNB produced a higher significant [p<0.05] improvement in rest pain, movement pain and tenderness at week 1, as compared to distension during arthrography. The percentage of patients using analgesics and the number of analgesic use per day decreased significantly [p <0.05] in both groups. Also, SSNB had a more significant decrease [p <0.05] of analgesic usage at week 1, compared to distension during arthrography. Regarding ROM, most planes of shoulder movements [active and passive], improved significantly [p<0.001] in both groups compared to baseline, which was maintained up to 12 weeks. There was no significant difference between the 2 groups except for the improvement of passive abduction at weeks 4 and 12, passive external rotation and passive flexion at week 12, the improvement of these movements was significantly higher [p<0.05] in patients treated with therapeutic distension during arthrography. As for subjective evaluation, there was no significant difference between the two groups. In group I, the percentages of patients who were satisfied or improved, were 70%, 85% and 82% at weeks 1, 4 and 12 respectively. In group II these percentages were 75%, 80% and 69% respectively. No significant adverse effects of both treatments were recorded. Therapeutic shoulder distension during arthrography with steroid injection and suprascapular nerve block are safe, effective and reliable methods in the treatment of idiopathic frozen shoulder. Also, suprascapular nerve block produces more pain relief especially early after treatment while therapeutic shoulder distension during arthrography gives more improvement in ROM in long term. So combination of both methods could be recommended to get advantages of each modality

Compartive study of laser therapy Vs local steroid injections of apophyseal joints in rehabilitation of chronic low back pain

Fifty patients presenting with chronic low back pain [LBP] were divided randomly into two groups: Group I including 25 patients treated by laser therapy [12 sessions in 4 weeks], Group II including 25 patients treated by corticosteroid injections of apophyseal [facet] joints [3 injections, once weekly]. Patient's disability pain severity tenderness on palpation and lumbar mobility were assessed at study entry [baseline], at end of and one month after treatment. Patient perception of benefit was also evaluated at end of and one month after treatment. In group I, there was a highly significant improvement [p < 0.001] in disability, pain, and tenderness at the end of treatment as compared to baseline. However these improvements tended to decrease at one month after treatment. It was also found that there was no significant improvement in lumbar mobility at any time compared with baseline. While in-group II, at end of treatment, there were highly significant improvements [p < 0.001] in disability, pain and tenderness and significant improvement [p < 0.05] in lumbar mobility compared with baseline. These improvements were maintained up to one month after treatment. Regarding patient perception of benefit, there was no significant difference between the two groups at end of treatment, but group II had better results with significant difference compared with group I at one month after treatment No significant hazards were reported by patients in both groups. For rehabilitation of patients with chronic LBP, local corticosteroid injections of facet joints is better than laser therapy because laser therapy produces limited improvements which tend to lessen with time