Surgical repair of penile fracture

To evaluate the preoperative diagnostic methods and the outcome of surgical treatment of penile fractures in patients treated at our institution. Retrospective study. Department of Surgery, Urology Unit, Al-Jahra Hospital, Kuwait. Eighteen patients treated surgically for penile fracture during the period from October 2007 to June 2012 were included. The diagnosis of penile fracture was made on clinical grounds and penile ultrasonography. Patients were treated by immediate surgery. Corpus cavernosum tear was repaired with absorbable sutures. Surgical repair with absorbable sutures. Evaluation of preoperative diagnostic methods and the results of early surgical treatment. Patients presented within 6 - 20 hours [median time 16 hours] after injury. With a mean follow-up of 18 months [range 12 to 24 months], all patients were able to achieve full erection. No penile deformities or penile plaques were reported. Penile fracture represents a true urological emergency. In nearly all cases diagnosis can be made on typical history and clinical examination. Early surgical exploration and repair of tunica albuginea can result in good functional outcome

effect of prostate tissue inflammation in benign prostatic hyperplasia on enhancer of zeste homolog 2 ribonucleic acid expression

Enhancer of zeste homolog 2 [EZH2] has been recently found to regulate several genes involved in immunoresponse and autocrine inflammation network. The aim of the study was to quantitate EZH2 messenger ribonucleic acid [mRNA] expression, evaluate its relation to conditions of prostatitis associated with benign prostatic hyperplasia [BPH], and correlate it with the levels of the inflammatory marker interlukin 6 [IL-6]. Cross-sectional study in Middle Eastern men with BPH and prostatitis or BPH only. Transrectal ultrasound-guided prostate biopsies were collected from 106 patients suspected of having prostate cancer; however, the histology revealed BPH. Upon further pathological examination, 56 of these cases were identified as BPH with prostatitis and classified as: acute prostatitis [n=13]; active chronic prostatitis [n=32]; and, chronic inactive prostatitis [n=12]. Serum IL-6 levels and EZH2 mRNA expression were measured and compared between patient groups. EZH2 mRNA was overexpressed in BPH with prostatitis patients compared to BPH only patients [P<.0001]. BPH with active chronic prostatitis had higher EZH2 expression than BPH with acute or chronic inactive prostatitis compared to BPH only [P=.05 and .73, respectively]. EZH2 mRNA expression showed a negative correlation with IL-6 concentrations in BPH with prostatitis patients [rs=-0.31, P=.02]. EZH2 overexpression was associated with an increased risk of having BPH with prostatitis [crude odds ratio 0.20, 95% CI 0.06-0.65, P=.0076]. EZH2 mRNA expression correlates positively with prostatitis conditions associated with BPH and negatively with serum IL-6 levels. This supports the possible involvement of EZH2 mRNA overexpression in the development of prostate inflammation, and its new regulatory role in suppressing the expression of some inflammatory network genes

Urinary survivin mRNA expression and urinary nuclear matrix protein 22 BladderChek[R] and urine cytology in the detection of transitional cell carcinoma of the bladder

To compare the diagnostic performance of urine cytology [UC], survivin mRNA expression, and the NMP22 BladderChek[R] [NMP22BC] test for the detection, grading and staging of transitional cell carcinoma [TCC] of the bladder. Voided urine samples collected from 25 healthy controls and 80 patients diagnosed with TCC of the bladder were subjected to UC, the NMP22BC test and reverse-transcription real-time PCR for survivin mRNA expression. Survivin mRNA expression showed the highest sensitivity [87.5%] followed by the NMP22BC test [61.3%] while UC exhibited the lowest sensitivity [40%]. All three urine markers had a similar specificity of 96% [95% CI 80.5-99.3%]. Survivin mRNA expression was the only urine marker that showed a significant difference in relation to tumour histological grade [X[2] 8.5, p = 0.015]. None of the three urine markers was significantly related to tumour pathological stages. The diagnostic sensitivity of urinary urviving mRNA expression was superior to that of UC and the NMP22BC test and correlates with tumour pathological grade but not stage

Survivin downregulation is associated with vasectomy-induced spermatogenic damage and apoptosis

To evaluate the expression of the apoptotic genes survivin, Bax and Bcl-2 in vasectomized rabbits and to determine their relation with vasectomy-induced spermatogenic impairment and germ cell apoptosis. Twelve adult rabbits [6-12 months old] were divided into three groups: sham control, unilateral vasectomy or bilateral vasectomy. Six months after vasectomy, testicular tissue was analyzed for germ cell apoptosis and DNA fragmentation by the TUNEL assay and gel electrophoresis, respectively. Spermatogenesis was assessed using the Johnsen score. The relative gene expression of survivin, Bax and Bcl-2 was measured using reverse transcription followed by reAl time PCR. Compared to sham animals, a significant decrease in testicular survivin mRNA levels was measured in the two vasectomy animal groups [p<0.05]. This was accompanied by a significant increase in the Bax:Bcl-2 ratio in the vasectomized animals [p<0.05]. In addition, these data showed positive correlation with enhanced apoptotic index, damage to spermatogenesis and DNA fragmentation after vasectomy. These findings demonstrate that vasectomy-induced damage to spermatogenesis due to testicular apoptosis may be associated with survivin downregulation and Bax overexpression

Failure to pass urine following transurethral resection of the prostate [TURP]: does the patient's mode of presentation determine the outcome of TURP?

To elucidate possible predictive factors for failure to pass urine following transurethral resection of the prostate [TURP] in patients subjected to TURP for lower urinary tract symptoms [LUTS] secondary to benign prostatic hypertrophy [BPH]. Prospective Study. Urology Unit, Department of Surgery, Mubarak Hospital, Kuwait. Three hundred and fifteen consecutive patients who presented with LUTS secondary to BPH and underwent TURP were included in the study. TURP. Main Outcome Measure: Ability to void after TURP. Out of 315 patients, 26 [8.3%] failed to void after TURP. The mean age of patients was 67 [range 57-92] years. The causes of failure to void after the catheter removal were: hypotonic bladder [10 / 26, 38%], persistent infra-vesical obstruction [9/ 26, 35%], diabetic neuropathy [4/ 26, 15%], end stage renal failure neuropathy [1 /26, 4%] and old age [2/ 26, 8%]. 21 / 26 [80.7%] patients who failed to void presented with acute on chronic or chronic urinary retention. The etiology of failure to void post-TURP is multi-factorial but is more common in patients presenting with acute on chronic or chronic urinary retention secondary to hypotonic bladder, diabetic neuropathy and occasionally very old age. Careful pre-operative patient selection and counseling is required in patients with chronic urinary retention about to undergo TURP to minimize the frustrations associated with the management of patients failing to void post-TURP

twelve-year experience in the management of calciphylaxis resulting in penile gangrene

To analyze the mode of presentation of patients with calciphylaxis induced penile gangrene and the outcome of management of the disease Prospective study [1998 - 2010] Urology Unit, Mubarak Hospital, Kuwait Patients presenting with penile gangrene secondary to calciphylaxis were analyzed. Intervention[s]: Patients with moderate to severe penile gangrene had penile amputation Main Outcome Measure[s]: Etiological factors, mode of presentation, patient characteristics and the outcome of management Eleven patients were managed in the 12-year period. All patients [100%] had end stage renal failure [ESRF] and nine patients [81.8%] were on chronic dialysis at presentation. Poorly controlled diabetes mellitus was a co-morbidity in 10 patients [90.9%]. Areas of gangrene were limited to the glans penis in nine patients [81.8%] and extending to the scrotum in two patients [19.2%]. All patients had generalized calcified blood vessels on plain X-ray of the abdomen and pelvis. Eight patients [72.7%] required partial or total amputation of the penis. Three patients were successfully managed by debridement while one of them was too ill for surgical intervention. Seven patients [63.6%] were dead within three months of the diagnosis of penile gangrene. Penile gangrene due to calciphylaxis is a rare disease seen mostly in patients with ESRF on chronic dialysis. Poorly controlled diabetes is a risk factor for the onset of penile gangrene. The disease has a high mortality in older patients with other co-morbid medical diseases. Immediate penile amputation may result in a satisfactory outcome in less than 50% of all patients

Comparative efficacy of two methods of skin preparation of the perineal and genital skin of male urological patients

To compare the efficacy of two methods of skin antiseptic preparations of the genitalia and perineum in male urological patients. Prospective study. Mubarak Hospital, Kuwait. Adult male patients of two study groups numbering 114 [group-1] and 117 [group-2] admitted for cystoscopic procedures. The perineum and genitalia of patients in both groups were prepared by applying chlorhexidine-cetrimide mixture [CCM] and CCM plus povidone-iodine solution respectively. Swab specimens were obtained from the perineum and genitalia, before cleaning and disinfection [specimen A], after disinfection and draping [specimen B] and after the completion of the operative procedure [specimen C]. Specimens were cultured on appropriate media and representative colonies identified by standard methods. In groups 1 and 2, the A specimen yielded bacterial growth in 35.1 and 63% of patients, respectively. The commonest isolates in both groups were Gram-positive bacteria [89.2%] while Gram-negative bacteria accounted for only 10.8%. The B and C specimens in group-1 yielded positive bacterial culture in 7.1 and 11.4% patients respectively. In group-2, specimens B and C yielded bacterial growth in 5.1 and 2.6% patients respectively. In both groups, there was a significant reduction of patients with culture-positive B specimens after skin disinfection [p < 0.001]. The isolation rate of bacteria in specimen C in group-2 was significantlylower than group-1 patients [p < 0.001]. The addition of povidone-iodine to the CCM based regimen of perineal skin antiseptic preparation is associated with longer and more effective skin disinfection in male urological patients

Luteinizing hormone-Releasing hormone analogue-Induced cataract in a patient with prostate cancer

To report a case of right posterior subcapsular cataract induced by 3-monthly depot luteinizing hormone-releasing hormone [LHRH] analogue therapy in a patient with early prostate cancer. A 52-year-old male with static myopia of several years' duration was given a 3-month depot LHRH analogue [goserelin 10.8 mg] as part of neoadjuvant treatment for early prostate cancer. Four weeks after the treatment, the patient developed right posterior subcapsular cataract commonly associated with steroid treatment. The patient had right eye cataract extraction followed by insertion of a new lens. This report shows a case of a posterior subcapsular cataract as an adverse reaction to depot goserelin acetate. This is a feature commonly seen in steroid-induced cataract. Patients with prostate cancer and poor vision if due to cataract may not be ideal patients for depot preparations of LHRH analogues

Epididymo-orchitis and testicular abscess caused by salmonella enteritidis in immunocompromised patients in Kuwait

To report relatively uncommon presentations of epididymo-orchitis and testicular abscess caused by Salmonella spp. in 2 immunocompromised patients. A 56-year-old man, a known case of systemic lupus erythematosus on azathioprine and prednisolone therapy, developed urinary tract infection followed by bacteremia and epididymo-orchitis. Both urine and blood cultures yielded Salmonella enteritidis strains, which were demonstrated by pulsed-field gel electrophoresis typing method to be genotypically identical. The second patient, a 55-year-old diabetic [type II], presented with a testicular abscess from which a pure culture of S. enteritidis was obtained. Both were treated with intravenous piperacillin and amikacin followed by oral ciprofloxacin, responded well to the therapeutic regimen and were discharged home well. Their follow-ups were uneventful. This report shows that it is important to consider Salmonella infection in the differential diagnosis of inflamed and tender testis in immunocompromised patients and to include blood, urine and stool cultures in all cases

Reference intervals for important serum sex steroid hormones, prostate specific antigen, insulin like growth factor 1 and IGF binding protein 3 concentration in a normal Kuwaiti adult male population

The purpose of this study was to determine the age-specific reference ranges for some important male sex steroid hormones, prostate-specific antigen [PSA], insulin-like growth factor-1 [IGF-1], and IGF binding protein-3 [IGFBP-3], for the Kuwaiti population. Blood samples were taken from 398 consenting, fasting, healthy Kuwaiti males aged 15-80 years between 8.00 a.m. and 12.00 noon. The serum concentrations of total testosterone [TT], dehydro-epiandrosterone sulfate [DHEAS], androstenedione [ADT], sex hormone binding globulin, luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin, PSA, IGF-1 and IGFBP-3 were determined. A distribution curve was plotted and age-specific reference levels were determined for each analyte. The reference interval for parameters with a normal distribution [Gaussian] was mean +/- 2 SD, while for the non-normal distribution [non-Gaussian], it was 2.5-97.5 percentile. The reference intervals for the analytes obtained from this study were compared with those suggested by the kit manufacturers and currently used by the Ministry of Health, Kuwait Laboratories [MOHKL]. Serum IGFBP-3 and ADT had normal distribution while other analytes had non-normal distribution. The reference intervals from this study, manufacturers kit and MOHKL were as follows: TT 3-31, 9-60, 8-35 nmol/l; DHEAS 0.9-11, 1.0-7.3, 2.2- 15.2 micro mol/l; ADT 0.5-4.3, 0.8-2.8, 2.0-9.2 nmol/l; LH 1-11, 0.8-7.6, 0.4-5.7 mIU/l; FSH 0.5-11, 0.7-11.1, 1.1-13.5 mIU/l; prolactin 42-397, 53-360, 80-230 nmol/l; IGF-1 41-542, 78-956, 71-261 ng/ml; IGFBP-3 88- 2,090, 900-4,000, 900-4,000 ng/ml, and PSA 0-3.1, 0-4, 0-4 ng/ml, respectively. These data indicate that for Kuwaitis lower reference ranges must be used for serum TT, DHEAS, ADT, IGFBP-3 and PSA. There is no need to change the currently used reference interval for FSH whereas higher values must be used for LH, prolactin, and IGF-1

Anuria secondary to hot weather-induced hyperuricaemia: diagnosis and management

There is little information on the management of anuria secondary to severe volume depletion or as a rare manifestation of heat stroke in areas of the world with very hot summers. We present our experience with hot weather-induced hyperuricaemia in Kuwait. Patients and Patients presenting to our urology unit as an emergency during the hot summer months of April to October [average temperature 40-55oC] were suspected of having hot weather-induced anuria secondary to hyperuricemia if they had a history of working in the sun for 6 to 8 hours per day and a progressive decrease in urine output to complete anuria. The diagnosis was confirmed by demonstration of elevated serum creatinine and uric acid, ultrasound findings of normal kidneys, ureters, and bladder [KUB] or mild to moderate hydronephrosis, but no features of chronic renal disease and little or no urine in the bladder. Management consisted of emergency cystoscopy, retrograde pyelogram, ureterorenoscopy [URS], and