Prostate inflammation. Association with benign prostatic hyperplasia and prostate cancer

To study the association and possible relationship of prostate inflammation with benign prostatic hyperplasia [BPH], and prostate cancer. The medical records and pathological findings of all Saudi patients who underwent transrectal ultrasound guided prostatic needle biopsies in King Abdulaziz University Medical City, Jeddah,Kingdom of Saudi Arabia from June 2003 to June 2008 were reviewed retrospectively. The indications for biopsy were elevated levels of serum prostate specific antigen, abnormal findings on digital rectal examination, or both. The specimens harboring inflammation, adenocarcinoma, BPH, or their combinations, were selected and included in the study. A total of 214 patients were selected with an age ranging from 37-100 years [median=68]. Inflammation was histologically evident in 88 patients. Of them, only one demonstrated acute inflammation, while 87/88 demonstrated chronic inflammation with, or without acute inflammation. Histopathologic features were categorized into 3 main categories: inflammation alone [12/214, 5.6%], BPH category [126/214, 58.9%], and cancer category [76/214, 35.5%] patients. The last 2 categories also included cases associated with inflammation. In the overall analysis of 214 specimens, BPH with inflammation was more prevalent than cancer with inflammation [43/214 [20.1%] versus 33/214 [15.4%]]. In a subgroup analysis within each category, inflammation was less prevalent in the BPH category compared to the cancer category [43/126 [34.1%] versus 33/76 [43.4%]]. The association between chronic inflammation and both BPH and cancer is obvious in our study. Further studies are needed to substantiate this observation, and to clarify the magnitude of association of inflammation with BPH compared to cancer

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

Lack of detection of human papillomavirus infection by hybridization test in prostatic biopsies

To explore the possibility of finding human papillomavirus [HPV] infection in the prostate tissue of a cohort of Saudi men presenting with benign prostatic hyperplasia [BPH] or prostate cancer. A cohort study on prospectively collected tissue samples was conducted at King Abdulaziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia from March 2007 to December 2008 on a total of 56 male patients, age range 50-93 years [average 68], diagnosed as having BPH or prostate cancer. The HPV DNA hybridization by hybrid capture 2 technology was performed on prostate biopsies of these patients to detect 18 types of HPV infection, and differentiate between 2 HPV DNA groups, the low-risk types, and the high/intermediate risk types. The tissues of all the prostatic biopsies were negative for HPV DNA. Our results, using the hybridization test, indicate that it is unlikely that HPV-16 or HPV-18, or the other tested subtypes, enhance the risk of prostate cancer

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

Urethral polyp verumontanum

Congenital posterior urethral polyps are rare benign lesions that can cause a variety of symptoms in young boys, the diagnosis is usually made by cystourethrogram and ultrasonography where the polyp appears as a soft tissue mass arising at the base of the urinary bladder. We present a case of verumontanum polyp in a 7-year-old boy who presented to us in October 2001 with terminal hematuria, dysuria, interrupted stream and suprapubic pain. The polyp was diagnosed by ultrasonography and cystourethrogram. Transurethral resection of the polyp was performed and pathological assessment revealed a fibroepithelial lesion which is consistent with congenital posterior urethral polyp. After 18 months follow up, the patient was free of symptoms. We reviewed the literature to identify the presentation, diagnosis, treatment options and prognosis of these polyps. In the past 20 years the posterior urethral polyp has become more common than before, and it should be considered in boys with lower urinary tract dysfunction and hematuria

Fournier's gangrene in diabetic and renal failure patients

To report our experience in the management of 9 patients with Foumier's gangrene seen in our institute, to identify the most common prognostic variables in our patients, and to evaluate the outcome of aggressive management in patients with Fournier's gangrene. We reviewed the medical records of 9 patients admitted to King Abdul-Aziz University Hospital [KAUH] in Jeddah, Kingdom of Saudi Arabia from November 1999 until November 2002. Their age, sex, clinical presentation, predisposing factors, microbiology testing, management and prognosis were studied. Nine male patients were diagnosed and treated. The mean age was 68 years, 6 patients [66.6%] were diabetics and one of them had renal insufficiency not requiring dialysis, while 3 patients were on regular hemodialysis. Bacterial culture results revealed a single organism in 44.4%, and more than one organism in 55.6% of the cases. No anaerobes could be cultured, and one patient had C and ida albicans. All patients had temporary suprapubic catheter diversion while stool diversion by colostomy was required in only one patient. In 7 patients, aggressive debridement and parental antimicrobial were successful to eradicate the infection, whereas 2 patients [22.2% of the cases] died of uncontrolled sepsis. Foumier's gangrene is a very serious disease, underst and ing the criteria of early recognition of the disease, referral to the specialist, and aggressive debridement with the use of appropriate antimicrobial therapy will improve the outcome of the patients and decrease the mortality rate

Prostate cancer in Saudi Arabia in 2002

Epidemiologic studies revealed that there are variations in the geographic and ethnic distribution of cancer of the prostate [CaP] gland. This cancer varies dramatically between being very common in black American men, to rare in Asian and Chinese men. Genetic, familial predisposition and environmental factors in addition to methods of cancer detection and reporting contribute to these variations. Prostate cancer is the ninth most commonly diagnosed cancer in the world yet it ranks first in the United States of America [USA] where resources allow large epidemiological studies. The health policy makers take major decisions such as mass population screening according to data derived from such studies that include information on disease specific mortality rates and incidence rates for each of the ethnic sub-populations living in the USA. Until now, we do not have similar information in the Kingdom of Saudi Arabia [KSA]; therefore, policy decisions should consider the possibility of the difference in situations since genetic, familial and environmental conditions are different. Our current local data, although little, indicates that prostate cancer occurs at a lower incidence rate than western countries. The objective of this article is to provide all the available information on the different aspects of CaP gland in KSA. A second more important objective is to attract the attention of the future expectations that need preparation since the possibility of disease prevention does exist

Results of prostate biobsies in a teaching hospital in western Saudi Arabia

To evaluate the prostate cancer detection rate in 45 patients who underwent transrectal ultrasound scan [TRUS] guided biopsies at King Abdul-Aziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia [KSA] and compare it with the previously reported national and international rates. Forty-five charts reviewed for patients underwent TRUS guided biopsies in the period between July 1997 through to November 2002 at KAUH. Patients were entered in the study either as of high serum prostatic specific antigen [PSA] or abnormal digital rectal examination [DRE], or both. Cases with large prostate size or suspected elevation of PSA due to causes other than prostatic cancer was excluded from the study. Out of the 45 patients who underwent TRUS guided biopsy; cancer of the prostate was detected in 13 [28.8%]. The cancer detection rate in patients presented with abnormal DRE alone was 7.6%, and was 15.3% in the group with elevated PSA but normal DRE [stage T1c]. When PSA was elevated to 4-10ng/ml TRUS guided biopsy detected cancer in 21.4%, elevation of PSA to10-20ng/ml lead to cancer detection in 40% of the patients, and when PSA was above 20ng/ml all cases were positive for cancer. Cancer prostate is common in Western countries; national studies reported a low incidence of prostate cancer in KSA. Yet in our local patients using this precise method of investigation, our study confirms that the detection rate of prostate cancer through TRUS guided biopsies match the results of previously reported national studies and still lower than the international rates. Although the number of cases are small to draw solid and final conclusions; this study should stimulate further research and more reports on this important subject

Genital infection in males with idiopathic infertility

We investigated a group of male patients with idiopathic infertility to determine the presence of genital infection and to identify the pattern of this infection using a specially designed protocol. A prospective study was carried out on 63 patients and 23 controls. We cultured the first voided urine, semen and swabs taken from the anterior urethra of these patients and controls for bacteria, chlamydia, Ureaplasma urealyticum and Mycoplasma hominis. Two techniques were used for chlamydial isolation and identification. These involved the use of chlamydial culture on McCoy cells with culture confirmation test and the direct fluorescent identification of Chlamydia trachomatis. The all-liquid media [MYCOFAST ALL-IN] kits were used for the identification of mycoplasma. Our results indicate that there is a significantly higher incidence of genital infection among male patients with idiopathic infertility than in normal fertile controls [P=0.0004]. Extensive microbial investigations are indicated when genital infection is suspected to be the cause of the infertile state or cannot be ruled out as a possible cause in case of idiopathic infertility

Seminoma of an undescended testis presenting as incomplete large bowel obstruction

Seminoma is the most common neoplasm to arise in the undescended testicle. The clinical presentation of such a tumor is either as an abdominal mass or abdominal pain. A patient with a seminoma developing in an undescended testicle which presented as an incomplete large bowel obstruction is being reported. To our knowledge, such presentation has not been reported previously. The clinical presentation, investigations, treatment modalities, and long term follow-up result are described

Prolapsing introital masses in two young sisters: diagnosis and management

The diagnosis and management of two young Saudi sisters who presented with protruding masses in the introitus are described. The younger sister, aged three years, had Rhabdomyosarcoma of the urinary bladder, while the older sister, aged nine years, had urethral prolapse. Both conditions are rare. It as challenging and interesting to manage two sisters with similar symptoms, but totally different underlying diseases. Both were managed successfully

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

Combined transitional cell carcinoma and urothelial mucus-secreting adenocarcinoma of the renal pelvis

We report a rare case of multicystic, excessively mucus-secreting invasive adenocarcinoma of the renal pelvis, associated with both in situ and invasive transitional cell carcinoma and multiple renal calculi. The patient presented with an abdominal mass. The ultrasound and computerized tomography examinations mimicked those of giant hydronephrosis. A review of the literature indicates that less than 40 cases of mucus-secreting adenocarcinoma of the renal pelvis have been reported. The association of two types of carcinoma has been reported with slightly different criteria only once

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