Urinary continence after orthotopic urinary diversion

To assess, in a retrospective study, urinary continence after radical cystectomy and orthotopic urinary diversion using two types of neobladder [sigmoid and ileal neobladder] at the Urology Department of Al-Azhar University, Cairo, Egypt. Over an 8-year period, radical cystectomy followed by orthotopic urinary diversion in the form of W-ileal or sigmoid neobladder was performed in 223 patients with invasive bladder carcinoma. Only 150 patients who survived for one year after surgery were included in this study. The voiding pattern, diurnal and nocturnal frequency of micturition and the continence rates were evaluated subjectively and objectively. Urodynamic assessment was done for 70 continent patients and all patients with diurnal and nocturnal incontinence. The mean follow-up was 23 +/- 3 [range 12-43] months. A sigmoid neobladder was created in 92 [61.3%] and a W-ileal neobladder in 58 [38.7%] patients. Diurnal continence was experienced by 87 patients [94.6%] and 54 patients [93.1%] with sigmoid and W-ileal pouches, respectively. The overall rate of nocturnal enuresis was 34.7% [52 patients]; 20.7% [31 patients] after sigmoid pouch and 14% [21 patients] after W-ileal pouch. Both sigmoid and W-ileal pouch provide good diurnal and satisfactory nocturnal continence rates. As for urinary continence, no significant difference between the two types of neobladder was detected clinically or by urodynamic studies

Pathologic pattern of invasive bladder carcinoma: impact of bilharziasis

To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Between April 2002 and October 2006, 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department, Cairo, Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type, stage, grade and gross features in addition to lymph node involvement were particularly noted. Bilharzial bladder pathology [lesions or ova] was present in 105 [70.9%] of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma [TCC] in 84 [56.7%], squamous cell carcinoma [SCC] in 51 [34.5%], adenocarcinoma in 9 [6.1%] and anaplastic tumor in 4 [2.7%] of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23%, pT3 in 70.9% and pT4a involving the prostate or seminal vesicles in 6.1%. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 [48.6%] and high grade in 76 [51.4%] specimens. Regional lymph node involvement was detected in 31 [20.9%] specimens irrespective of bilharzial infestation. Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3, low-grade SCC and commonly appears as an ulcerative, bulky, fungating or verrucous mass. On the other hand, bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation

National Congenital Anomalies Register in the United Arab Emirates

The National Congenital Anomalies Register is a population-based register covering all births in the United Arab Emirates. We evaluated the progress of the register and determined the prevalence of congenital anomalies [CAs] and associated maternal and neonatal risk factors. Total prevalence of CAs for 1999-2001 was 7.89/1000, 10.95/1000 and 7.92/1000 for live births, stillbirths and total births respectively. Rates were comparable to international rates for all districts except Dubai, Fujairah and Ras Al Khaimah. According to the International classification of diseases, the cardiovascular system was the most affected followed by CAs of chromosomal and the musculo-skeletal system. Birth defects were more common with older maternal age, gr and multiparity, male babies, low-birth-weight babies and premature babies

Prevalence of hypertension in south-western Saudi Arabia

Prevalence of hypertension was surveyed in south-western Saudi Arabia. Hypertension was ascertained by measuring blood pressure under standard conditions and by interview for positive history. The overall prevalence was 11.1%, and the age-adjusted prevalence was 10.6% in men and 11.4% in women. Prevalence increased significantly by age. Among previously known cases, 76% were receiving treatment, but only 20% were found controlled. It is concluded that hypertension affects a sizeable proportion of Saudi communities. Further efforts are needed to improve control of the disease