clinicopathologic patterns of prostatic diseases and prostate cancer in Saudi patients

To determine the clinicopathologic patterns of prostatic diseases in Saudi patients, with special emphasis on prostate cancer [PCa]. The records of patients who underwent histopathological examinations of their prostatic specimens in King Abdulaziz University Medical City and King Faisal Specialist Hospital, Jeddah, Kingdom of Saudi Arabia, between June 2003 and June 2008 were reviewed retrospectively. The age, indications for biopsy, histological diagnosis, and Gleason grading of cancer patients, were studied. The study included 330 patients aged 37-100 years [median=68]. Specimens included 233 transrectal ultrasound [TRUS] biopsies, 85 transurethral resection of the prostate [TURP], 8 simple prostatectomies, 3 radical prostatectomies, and one radical cystoprostatectomy. Indications for TRUS guided biopsy in PCa patients were elevated prostate specific antigen [PSA] [85.2%], abnormal digital rectal examination [5.5%] or both [9.3%]. Prostate specific antigen values <4 ng/ml were found in 13.6% of PCa patients. Among others, adenocarcinoma was found in 28.5%, benign prostatic hyperplasia [BPH] alone in 43.3%, BPH with inflammation in 20.3% and inflammation alone in 4.2%. In specimens of TURP or simple prostatectomy for apparently benign disease, incidental PCa was detected in 14/93 [15%]. The Gleason sum of >/= 6 was found in 92.8% of patients. The incidence of prostate cancer in Saudi Arabia is low compared to the western countries. However, incidental PCa detected in presumed benign disease appears to be rising. Further future studies addressing this issue are needed to confirm the potential rising trend, and its possible etiology. Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5 rather than 4ng/ml

Shock wave lithotripsy in patients with renal calculi

To demonstrate the efficacy of shock wave lithotripsy [SWL] in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter. One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation [Pethidine 1mg/kg and Midazolam 5-10mg] for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months. Complete clearance of the stones occurred in 2154 kidneys [89.5%]. At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 [23.5%] for Group I, 254 [36.1%] for Gourp II, 473 [85.5%] for Group III, 278 [100%] for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction. Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys

Urologic double-J catheters: uses and complications

Urologic disorders comprise a large number of the health problems in Saudi Arabia. In addition to the high incidence rate of urinary calculi, bilharzial uropathy is frequently encountered and considered by urologists to be difficult to manage in its late stages. Cancer, genitourinary traumas and tuberculosis are other important diseases although less frequently encountered. Internally placed urinary catheters known as double-J catheters are now widely used by urologists in the management of the above mentioned diseases. This article is presented with the intention of familiarising the general reader with those commonly used catheters, and supplying specific information on their complications and the management of these complications based on our experience with 120 patients seen at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia

Second-generation shockwave lithotripter [Lithostar]: experience with the first 300 patients treated at King Abdulaziz University Hospital in Jeddah

A total of 300 patients [7-71 years old] with urinary stones were treated with a second-generation lithotripter [Lithostar]. All treatments were given on an out-patient basis. General anaesthesia was used only for one patient. Intravenous analgesia was used for 241 patients, while no sedation or analgesia was necessary in 58 patients. Auxiliary measures were required for 73 patients [27.3%]. Fragmentation was achieved in 96.6% of the cases. Stone-free status was achieved in 139 patients [68.1%], while 23 patients [11.4%] had insignificant residual, and 35 patients [17.3%] had significant residual stone fragments. Repeated treatment sessions were needed for 19.5% of the patients

Clean intermittent catheterization in the management of children with neurogenic vesicle dysfunction

Clean intermittent catheterization [CIC] has been shown to be an effective, safe and an easy method of managing patients with neurogenic vesical dysfunction. A total of seventy four children with neurogenic vesical dysfunction were treated with CIC at two institutes. There were children from the Children's Hospital of Eastern Ontario [CHEO] in Ottawa, Canada, and eleven patients from King Abdulaziz University Hospital [KAUH] in Jeddah, Saudi Arabia. The complication rate encountered was low. Most patients demonstrated stable upper urinary tracts. One of our patients as only four months old. In some patients vesico ureteral reflux improved without surgical intervention. Chronic indwelling catheterization or supravesical diversion are alternatives that are associated with morbidity and mortality

Wilm's tumor: King Abdulaziz University Hospital experience

Wilms' tumor is the most common renal neoplasm of infancy and childhood. Twelve patients with histologically confirmed Wilms' tumor were treated over a 4-year period at King Abdulaziz University Hospital in Jeddah. Two thirds of our patients presented with stage 2 and 3 tumors, the use of combination therapy gave a survival percentage similar to that reported from Western centers