Validity of prostate health index and percentage of [-2] pro-prostate-specific antigen as novel biomarkers in the diagnosis of prostate cancer: omani tertiary hospitals experience

Objectives: Prostate cancer is the leading cancer in older men. The Ministry of Health Oman Cancer Incidence Registry 2013 lists cancer of the prostate as the first most common cancer in males. Therefore, early detection is important and prostate-specific antigen [PSA] is widely used as an established laboratory test. However, despite its wide use, its value in screening, particularly in asymptomatic males, is controversial when considering the risks and benefits of early detection

Methods-. This prospective, observational study included 136 males [67.0+/-8.9 years; range 45-90] who were scheduled for a prostate biopsy in two different tertiary care teaching hospitals in Oman: the Royal Hospital and Sultan Qaboos University Hospital. Blood specimens from these patients were collected at the same setting before obtaining a prostatic biopsy

Three PSA markers [total PSA [tPSA], free PSA [fPSA], and [-2]proPSA [p2PSA]] were measured and the Prostate Health Index [phi] calculated. The histopathological report of the prostatic biopsy for each patient was obtained from the histopathology laboratory of the concerned hospital along with clinical and laboratory data through the hospital information system. Results: Phi has the highest validity markers compared with other prostate markers, with a sensitivity of 82.1%, specificity of 80.6%, and area under the curve [AUC] value of 0.81 at a cutoff of 41.9. The other prostatic markers showed sensitivities and specificities of 78.6% and 25.9% for tPSA; 35.7% and 92.6% for%fPSA; and 64.3% and 82.4% for%p2PSA, respectively. The AUCs at the best cutoff values were 0.67 at 10.1 pg/L for tPSA; 0.70 at 11.6% for%fPSA; and 0.55 at 1.4% for%p2PSA. An association between phi values and aggressiveness of prostate malignancy was noted. Of the 28 patients with prostate cancer, 22 patients had tPS A > 4 [ig/L. However, no patient had phi in the low-risk category, and five, six, and 17 patients had phi in the moderate-, high-, and very high-risk categories, respectively. Conclusions: Phi outperforms tPSA and f PSA when used alone or in combination, and appears to be more accurate than both markers in excluding prostate cancer before biopsy. Use of this biomarker helps clinicians to avoid unnecessary biopsies, particularly in patients with gray-zone tPSA level. Phi is the strongest marker that correlates proportionally with Gleason Score; therefore, it is also useful in predicting the aggressiveness of the disease. This is the first reported experience for the use of p2PSA and phi in Oman, the Middle East, and North Africa

Extracorporeal shock-wave lithotripsy success rate and complications: initial experience at Sultan Qaboos university hospital

To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones. Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance. Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 [85%] had renal stones and 33 [15%] had ureteric stones. The mean +/- SD stone size was 11.3 +/- 4.5 mm, while the mean age of the patients was 39.9 +/- 12.8 years with 68.5% males. The mean renal stone size was 11.6 +/- 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 +/- 3 mm; and a mean of 1.3 sessions was required. Treatment success [defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones] was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients [38.5%] with renal stones and 13 patients [39.4%] with uretetric stones. The most common complication was loin pain [experienced by 16.7% with renal stones and 21% with ureteric stones]. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine [p=0.004] and the number of shockwaves [p=0.021]. Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones

Urolithiasis in an adult with primary obstructive megaureter: a case report

This is a rare case of adult primary obstructive megaureter complicated by combined uric acid-oxalate lithiasis of the ureter and renal stones. A 24-year-old male patient presented with frank hematuria on exercise of 4 years duration. The patient had an open surgery in the form of excision of stenotic segment of ureter and left ureteric re-implantation with removal of ureteric and renal stones. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms

Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder

The optimal time of cystectomy for nonmuscle invasive bladder cancer [NMIBC] is controversial. This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients [group 1] and deferred cystectomy was done after failed conservative treatment in 70 [group 2] Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Cancer-specific survival was calculated using the Kaplan-Meier method. Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year [84% in group 1 vs. 79% in group 2], 5-year [78% vs. 71%] and 10-year [69% vs. 64%] cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors [TURBT] than in cases with fewer TURBTs. Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category

Small incidental renal masses in adults: review of the literature

Incidental renal tumours are becoming an important clinical problem that many physicians will need to deal with. A good knowledge of the nature of these tumours and how to manage them is therefore needed. The aim of this paper is to review the literature about incidental renal tumours in adults. Many incidentally discovered small renal tumours [<4 cm] are benign and of low stage, grade and progression potential. The preferred management in young fit patients is open or laparoscopic nephron-sparing surgery. Treatment alternatives include needle-ablative therapies and surveillance in elderly unfit patients. Tumour renal biopsy is encouraged prior to needle-ablative therapy and surveillance. Awareness about incidental renal masses and their management is essential for treating doctors

Keyhole surgery of the kidney at Sultan Qaboos University Hospital, Oman

Percutaneous access surgery of the kidneys was introduced in Sultan Qaboos University Hospital [SQUH] in 1998. We are presenting our early experience in the first 31 patients operated on over an eight year period using the percutaneous approach. A retrospective review of 25 patients, who underwent percutaneous nephrolithotomy [PCNL] for the treatment of large renal stones and 6 patients who underwent endopyelotomy for the treatment of pelviureteric junction [PUJ] obstruction. In the PCNL group complete stone clearance was achieved in 68% [17/25] patients and the complication rate was 28% [7/25]. In the endopyelotomy group the success rate of relief of obstruction of PUJ measured by renogram and relief of symptoms was 83% [5/6 patients]. Our early results of PCNL are promising and comparable to international results

Plastibell circumcision: How safe is it? experience at Sultan Qaboos University Hospital

Plastibell circumcision complications can be life-threatening. The aim of this paper is to review the complications of Plastibell circumcision reported in the literature and in our own patients to determine the safety of the procedure. A retrospective study of 171 neonates circumcised in Sultan Qaboos University Hospital over a 4-year period from 1997 to 2000. Minor complications occurred in 4 [2.3%] of circumcisions. Two cases were converted to formal circumcision due to bleeding and failure to introduce the bell respectively. One had delayed passage of urine for 24 hours and in one neonate, the parents were concerned about inadequate removal of foreskin. Plastibell circumcision is a safe technique in experienced hands. The risk of complications with this procedure is increased eight-fold when performed by nurses compared to surgeons