Bone mineral density in patients with metastatic prostate cancer with or without androgen deprivation therapy

Prostate cancer commonly metastatize to skeletal sites. Androgen deprivation therapy [ADT], the primary treatment of metastatic prostate cancer, may result in osteoporosis. Bone mineral density evaluation during androgen deprivation therapy can detect patients at risk of osteoporotic fractures

Objectives: 1-To determine BMD [T-score] in patients with metastatic prostate cancer with or without androgen deprivation therapy. 2-To compare BMD in metastatic prostate cancer patients with age matched controls

Study Design: case-control study

Setting: Urology Department, Allied Hospital Faisalabad

Materials and Methods: BMD of patients with metastatic prostate cancer [30 with ADT, 30 without ADT sampled with nonprobability convenience method] were compared with age matched control group of 60 subjects. Inclusion criteria. Group-I: 60-80 years aged consecutive patients of carcinoma prostate who have been taking anti androgen therapy at least six months. Group-II: 60-80 years consecutive patients with metastatic prostate cancer who have not started any antidrogen deprivation therapy. Group-III: 60-80 years aged healthy men from general population [preferably from patient's family] without prostate cancer. Exclusion criteria: From all groups, men taking for any reason, chemotherapy, radiation thyroxin, warfarin, corticosteroids, methrotrexate, anticonvulsants, post organ transplant therapy, chronic heparin, antipsychotic medications, long term lithium therapy and calciuretic diuretics were not included in the study

Results: Out of 120 subjects, 31% had normal BMD, 27% osteopenia, 42% osteoporosis. In metastatic prostate cancer patients taking ADT [n=30], 7% subjects had normal BMD, 37% osteopenia and 56% osteoporosis. In metastatic prostate cancer patients without ADT [n=30], 13% subjects had normal BMD, 63% osteopenia, 24% osteoporosis. In healthy controls [n=60], 52% subjects had normal BMD, 33% osteopenia, 15% osteoporosis

Conclusions: BMD is affected by prostate cancer and its treatment. Bisphosphonates use should be rationalized according to the patients need

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases