Validity of Prostate Health Index and Percentage of [-2] Pro-Prostate-Specific Antigen as Novel Biomarkers in the Diagnosis of Prostate Cancer: Omani Tertiary Hospitals Experience.

OBJECTIVES: Prostate cancer is the leading cancer in older men. The Ministry of Health Oman Cancer Incidence Registry 2013 lists cancer of the prostate as the first most common cancer in males. Therefore, early detection is important and prostate-specific antigen (PSA) is widely used as an established laboratory test. However, despite its wide use, its value in screening, particularly in asymptomatic males, is controversial when considering the risks and benefits of early detection. METHODS: This prospective, observational study included 136 males (67.0±8.9 years; range 45-90) who were scheduled for a prostate biopsy in two different tertiary care teaching hospitals in Oman: the Royal Hospital and Sultan Qaboos University Hospital. Blood specimens from these patients were collected at the same setting before obtaining a prostatic biopsy. Three PSA markers (total PSA (tPSA), free PSA (fPSA), and [-2]proPSA (p2PSA)) were measured and the Prostate Health Index (phi) calculated. The histopathological report of the prostatic biopsy for each patient was obtained from the histopathology laboratory of the concerned hospital along with clinical and laboratory data through the hospital information system. RESULTS: Phi has the highest validity markers compared with other prostate markers, with a sensitivity of 82.1%, specificity of 80.6%, and area under the curve (AUC) value of 0.81 at a cutoff of 41.9. The other prostatic markers showed sensitivities and specificities of 78.6% and 25.9% for tPSA; 35.7% and 92.6% for %fPSA; and 64.3% and 82.4% for %p2PSA, respectively. The AUCs at the best cutoff values were 0.67 at 10.1 µg/L for tPSA; 0.70 at 11.6% for %fPSA; and 0.55 at 1.4% for %p2PSA. An association between phi values and aggressiveness of prostate malignancy was noted. Of the 28 patients with prostate cancer, 22 patients had tPSA > 4 µg/L. However, no patient had phi in the low-risk category, and five, six, and 17 patients had phi in the moderate-, high-, and very high-risk categories, respectively. CONCLUSIONS: Phi outperforms tPSA and fPSA when used alone or in combination, and appears to be more accurate than both markers in excluding prostate cancer before biopsy. Use of this biomarker helps clinicians to avoid unnecessary biopsies, particularly in patients with gray-zone tPSA level. Phi is the strongest marker that correlates proportionally with Gleason Score; therefore, it is also useful in predicting the aggressiveness of the disease. This is the first reported experience for the use of p2PSA and phi in Oman, the Middle East, and North Africa.

Urinary stone composition in Oman: with high incidence of cystinuria.

Urinary stones are a common problem in Oman and their composition is unknown. The aim of this study is to analyze the components of urinary stones of Omani patients and use the obtained data for future studies of etiology, treatment, and prevention. Urinary stones of 255 consecutive patients were collected at the Sultan Qaboos University Hospital. Stones were analyzed by Fourier transform infrared spectrophotometer. The biochemical, metabolic, and radiological data relating to the patients and stones were collected. The mean age was 41 years, with M:F ratio of 3.7:1. The common comorbidities associated with stone formation were hypertension; diabetes, benign prostate hyperplasia; urinary tract infection; obesity; and atrophic kidney. The common presentation was renal colic and flank pain (96%). Stones were surgically retrieved in 70% of patients. Mean stone size was 9 ± 0.5 mm (range 1.3-80). Stone formers had a BMI ≥ 25 in 56% (P = 0.006) and positive family history of stones in 3.8%. The most common stones in Oman were as follows: Calcium Oxalates 45% (114/255); Mixed calcium phosphates & calcium oxalates 22% (55/255); Uric Acid 16% (40/255); and Cystine 4% (10/255). The most common urinary stones in Oman are Calcium Oxalates. Overweight is an important risk factor associated with stone formation. The hereditary Cystine stones are three times more common in Oman than what is reported in the literature that needs further genetic studies.

Molecular Evidence of Helicobacter Pylori Infection in Prostate Tumors.

OBJECTIVES: To determine whether Helicobacter pylori (H. pylori) is detectable in both benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Epidemiological studies have shown significant associations between infective chronic prostatitis and prostatic carcinoma. Many bacteria have been found in the prostate of patients with chronic prostatitis, BPH, and PCa. METHODS: One hundred consecutive patients with prostate diseases were enrolled in the study. Detection of H. pylori DNA in prostate tissue from patients with BPH and PCa was performed using both immunohistochemistry and PCR, and the results were confirmed by DNA sequencing. Odds ratios and the Fisher Exact test were used for the analysis of the associations between the variables. RESULTS: Among the patients, 78% had BPH and 19% had PCa. While immunohistochemistry showed no positive sample for H. pylori, PCR combined with sequencing detected H. pylori DNA in prostate tissue samples from 5 patients. However, statistical analysis of the data showed that BPH and PCa are not significantly associated with the presence of H. pylori DNA in prostate tissue (odds ratio = 0.94, 95% confidence interval = 0.09-23.34, one-tailed Chi-square value = 0.660, p > 0.05). The limitation of this study was the small number of PCa patients. CONCLUSIONS: This study provides, for the first time, molecular evidence of the presence of H. pylori DNA in prostatic tissue of patients with BPH and PCa. It paves the way for further comprehensive studies to examine the association of H. pylori infection with BPH and PCa.

Urolithiasis in an adult with primary obstructive megaureter: a case report.

This is a rare case of adult primary obstructive megaureter complicated by combined uric acid-oxalate lithiasis of the ureter and renal stones. A 24-year-old male patient presented with frank hematuria on exercise of 4 years duration. The patient had an open surgery in the form of excision of stenotic segment of ureter and left ureteric re-implantation with removal of ureteric and renal stones. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.

Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital.

OBJECTIVE: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones. METHODS: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance. RESULTS: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85%) had renal stones and 33 (15%) had ureteric stones. The mean±SD stone size was 11.3±4.5 mm, while the mean age of the patients was 39.9±12.8 years with 68.5% males. The mean renal stone size was 11.6±4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9±3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones) was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5%) with renal stones and 13 patients (39.4%) with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones). Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004) and the number of shockwaves (p=0.021). CONCLUSION: Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones.

Complications and outcomes of JJ stenting of the ureter in urological practice: A single-centre experience.

OBJECTIVE: To determine the factors affecting the development of complications and the outcomes of JJ stenting. PATIENTS AND METHODS: The study included 220 patients (133 males and 87 females, mean age 39.5 years, SD 15.4) who had self-retaining JJ ureteric stents placed while in the authors' institution. Univariate and multivariate analyses were used to identify the significant variables affecting the development of complications and outcome of stenting (condition 'improved' or 'not improved'). RESULTS: Using a modified Clavien classification, there were grade I, II, IIIa, IIIb complications in 67 (30.4%), 39 (17.7%), two (0.9%) and 23 (10.5%) patients, respectively, and none of grades IVa, IVb and V. Loin pain (10.9%) and urinary tract infection (10.9%) were the most common complications, followed by dysuria (7.7%). There were significant complications requiring treatment in 29% of patients, and 71.4% of patients improved after stenting. On multivariate analysis the significant independent factor affecting the complication rate was the stent length (P = 0.016), and the significant independent factor affecting the 'improved' outcome was age (P = 0.014). CONCLUSION: Longer stents are associated with increased complication rates, and the older the patient the more likely they are to have a poor outcome after stenting. Future prospective multicentre studies with more patients are needed to confirm the present conclusions.

Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder.

CONTEXT: The optimal time of cystectomy for nonmuscle invasive bladder cancer (NMIBC) is controversial. AIM: This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. SETTINGS AND DESIGN: Between 1990 and 2004, a retrospective cohort of 204 patients was studied. MATERIALS AND METHODS: Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients (group 1) and deferred cystectomy was done after failed conservative treatment in 70 (group 2) Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. STATISTICAL ANALYSIS USED: Cancer-specific survival was calculated using the Kaplan-Meier method. RESULTS: Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year (84% in group 1 vs. 79% in group 2), 5-year (78% vs. 71%) and 10-year (69% vs. 64%) cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors (TURBT) than in cases with fewer TURBTs. CONCLUSIONS: Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category.

The role of biopsy in incidental renal tumours.

PURPOSE: Historically, the biopsy of renal masses was not advocated, and to date there remains some controversy on the role of biopsy for renal masses in making treatment decisions. With the widespread use of imaging methods, the incidental diagnosis of renal masses has increased, necessitating renal biopsies to better plan the management of these tumours. Here I review previous reports to define the role of biopsy in incidental renal tumours. METHODS: Data were obtained from English-language studies listed in PubMed on the use of renal biopsy for evaluating incidental solid small renal tumours. RESULTS: The biopsy of small renal tumours is increasingly accepted due to: the increase in the incidence of small renal tumours; the finding that a significant number of these tumours are benign; the availability of new management options, such as ablative therapy and surveillance strategies; that imaging alone is unable to predict the biological behaviour of these tumours; and advances in the pathological evaluation of the biopsies. The biopsy procedure has an acceptable complication rate but is not free of limitations. The current recommendations for the use of renal biopsy in small renal tumours are: to help in differentiating benign from malignant renal tumours; before or during ablative therapies and during the follow-up after ablative therapies, for defining treatment success or failure; and to exclude nonrenal cell primary tumours (metastasis and lymphoma) or benign conditions (abscess), which may not require surgery. CONCLUSIONS: The biopsy of small renal tumours is a safe and accurate procedure, and can help in the planning of definitive patient management.

Incidental vs symptomatic renal tumours: Survival outcomes.

PURPOSE: Currently there is an increase in the incidental diagnosis of renal cell carcinoma (RCC). Our aim was to assess the survival of patients with incidental and symptomatic renal tumours who had undergone nephrectomy. PATIENTS AND METHODS: We retrospectively assessed 604 patients who underwent renal surgery for RCC between 1983 and 2005. Patients were divided in two groups; group 1 had incidental and group 2 had symptomatic tumours. The median follow-up was 4 and 3.3 years for groups 1 and 2, respectively. All patients had surgery in the form of radical or partial nephrectomy. Sex, age, tumour size, type of surgery, pathological characteristics and patient survival in both groups were evaluated. The statistical analysis included the log-rank, Kaplan-Meier and Cox regression tests. RESULTS: There were 85 patients (14%) in group 1 (mean age 49.6 years) and 519 (86%) in group 2 (mean age 50 years). The mean (SEM, range) tumour size was 7.4 (0.4, 1.5-20) cm in group 1 and 9.7 (0.2, 2-38) cm in group 2 (P < 0.001). The most common stage was T1 (52%) and T2 (44%) in groups 1 and 2, respectively, with a predominance of G2 grade and the conventional type histology in both the groups. There was a significant difference in cancer-specific survival (CSS) between the groups (log-rank, P = 0.017). The 5- and 10-year CSS was 94% and 94% for group 1, and 82.5% and 79.5% for group 2. Cox regression analysis showed that in group 1, only the tumour mid-zonal location (P = 0.093), tumour stage pT (P < 0.001), grade 1 (P = 0.03), grade 2 (P = 0.01), grade 4 (P = 0.01) and the papillary histological type (P = 0.019) had significant effects on CSS. In group 2, only tumour size (P = 0.022) and stage pN (P = 0.003) had significant effects on CSS. The tumour recurrence rate was 18% and 29% for groups 1 and 2, respectively. CONCLUSIONS: This large study supports the findings of other smaller studies published previously, confirming that at presentation incidental renal tumours are smaller and their diagnosis provides a better prognosis and longer CSS.

What is the best drainage method for a perinephric abscess?

PURPOSE: To compare the results of percutaneous and open drainage for perinephric abscess. MATERIALS AND METHODS: The files of 86 patients who underwent drainage for perinephric abscesses from April 2001 through March 2008 were evaluated. The method of drainage for each patient was performed according to the clinical decision of the treating physician. Percutaneous tube drain (PCD) was used for drainage of the abscess in 43 patients (group 1), while the other 43 patients were managed with open drainage (group 2). Cure was defined as complete obliteration of the abscess cavity. The cure rates, complications, and hospital stay were compared between both groups. RESULTS: The study included 50 males and 36 females with mean age 44.2 + or - 17.3. The most common predisposing factors were diabetes mellitus and/or stones. Open drainage of perinephric abscesses resulted in a statistically significant higher cure rate (98% versus 69%, p < 0.001) and shorter hospital stay than PCD (3.6 versus 6 days, p < 0.001). Failure of complete drainage of multilocular abscess was observed in 8 of 13 cases (61.5%) in group 1 and one of 38 cases (2.6%) in group 2 (P < 0.001). Complications were observed in 7% of group 1 and 11.5% in group 2 (P = 0.45). After mean follow-up of 19 months, 9 of 46 patients (19.6%) had recurrence; 7 of them were in group 1. CONCLUSION: Percutaneous drainage of perinephric abscess is an effective minimally invasive treatment. However, PCD is not the optimal method for drainage of multilocular abscess because open surgical drainage provided higher cure rates and shorter hospitalization than PCD.

What is the best drainage method for a perinephric abscess?

Purpose: To compare the results of percutaneous and open drainage for perinephric abscess. MATERIALS AND METHODS: The files of 86 patients who underwent drainage for perinephric abscesses from April 2001 through March 2008 were evaluated. The method of drainage for each patient was performed according to the clinical decision of the treating physician. Percutaneous tube drain (PCD) was used for drainage of the abscess in 43 patients (group 1), while the other 43 patients were managed with open drainage (group 2). Cure was defined as complete obliteration of the abscess cavity. The cure rates, complications, and hospital stay were compared between both groups. Results: The study included 50 males and 36 females with mean age 44.2 ± 17.3. The most common predisposing factors were diabetes mellitus and/or stones. Open drainage of perinephric abscesses resulted in a statistically significant higher cure rate (98 percent versus 69 percent, p < 0.001) and shorter hospital stay than PCD (3.6 versus 6 days, p < 0.001). Failure of complete drainage of multilocular abscess was observed in 8 of 13 cases (61.5 percent) in group 1 and one of 38 cases (2.6 percent) in group 2 (P < 0.001). Complications were observed in 7 percent of group 1 and 11.5 percent in group 2 (P = 0.45). After mean follow-up of 19 months, 9 of 46 patients (19.6 percent) had recurrence; 7 of them were in group 1. CONCLUSIONS: Percutaneous drainage of perinephric abscess is an effective minimally invasive treatment. However, PCD is not the optimal method for drainage of multilocular abscess because open surgical drainage provided higher cure rates and shorter hospitalization than PCD.

Small Incidental Renal Masses in Adults: Review of the literature.

Incidental renal tumours are becoming an important clinical problem that many physicians will need to deal with. A good knowledge of the nature of these tumours and how to manage them is therefore needed. The aim of this paper is to review the literature about incidental renal tumours in adults. Many incidentally discovered small renal tumours (<4 cm) are benign and of low stage, grade and progression potential. The preferred management in young fit patients is open or laparoscopic nephron-sparing surgery. Treatment alternatives include needle-ablative therapies and surveillance in elderly unfit patients. Tumour renal biopsy is encouraged prior to needle-ablative therapy and surveillance. Awareness about incidental renal masses and their management is essential for treating doctors.

Comparison of endourological and open cystolithotomy in the management of bladder stones in children.

PURPOSE: Vesical stones are common in children in developing countries. Cystolithotomy is the traditional treatment but a percutaneous approach has been advocated. The aim of this study was to evaluate retrospectively our experience with percutaneous cystolithotomy, cystolitholapaxy and open cystolithotomy in children with bladder stones. MATERIALS AND METHODS: A total of 107 children (96 boys and 11 girls) with vesical stones were treated at our center between January 1992 and March 2008. Mean patient age at the time of diagnosis was 5 years (range 2 to 15). The patients were stratified retrospectively into 2 groups according to the procedure of stone removal. Group 1 (53 patients) underwent open cystolithotomy, and group 2 (54) underwent endourological treatment via the transurethral route (27) or the suprapubic approach (27). Stone size ranged from 0.7 to 5 cm (mean 2.8). RESULTS: In all cases the stones were removed successfully. Operative time was comparable in both groups. The hospital stay was significantly shorter after endourological procedures compared to open surgery (2.6 vs 4.8 days, p <0.05). In the open surgery group 1 patient had a small intestinal injury that necessitated repair, while in the endourological group 2 patients had urinary extravasation (1 urethral and 1 vesical). There were no early or late complications in group 1. In comparison, 4 patients (7.4%) in group 2 had early complications in the form of persistent urinary leakage from the suprapubic site and 1 patient had a bulbous urethral stricture 1 year after transurethral stone disintegration. CONCLUSIONS: Open and endourological management of vesical stones in children is efficient, with a low incidence of complications. Endourological management offers a shorter hospital stay compared to open surgery. However, open cystolithotomy seems to be safer.

Is there a role for Helicobacter pylori infection in urological diseases?

INTRODUCTION: Helicobacter pylori (H pylori) infection is a focus of attention nowadays. It has been found to cause gastrointestinal disorders and also extra-intestinal disorders. The aim of this paper is to explore the role of H pylori in urological diseases and to keep urologists up to date in this subject. MATERIALS AND METHODS: Medline and PubMed were searched from 1950 to December 2007 for the following combined terms: Helicobacter pylori together with urology, urological diseases, kidney, kidney cancer, ureter, bladder, bladder cancer, prostate, prostate cancer, benign prostatic hyperplasia, urethra, seminal vesicle, testis, and testicular cancer. RESULTS: Accumulating evidence is appearing in the literature relating H pylori infection to urological diseases. The most obvious is the implication of H pylori in inducing chronic cystitis leading to bladder lymphoma. In addition, some epidemiological studies have shown significant associations between infective chronic prostatitis and prostatic carcinoma. CONCLUSION: A simple hypothetical model relating H pylori infection to prostate and bladder diseases is proposed to stimulate the collaborative work between the urologists and scientists to explore this field which is underinvestigated to date. If H pylori is found to have a significant role in urological diseases, prevention of bladder and prostate cancers by eradication of H pylori infection may become a reality like what happened in the treatment of peptic ulcer disease and gastric cancer.

Keyhole surgery of the kidney at sultan qaboos university hospital, oman.

OBJECTIVES: Percutaneous access surgery of the kidneys was introduced in Sultan Qaboos University Hospital (SQUH) in 1998. We are presenting our early experience in the first 31 patients operated on over an eight year period using the percutaneous approach. METHODS: A retrospective review of 25 patients, who underwent percutaneous nephrolithotomy (PCNL) for the treatment of large renal stones and 6 patients who underwent endopyelotomy for the treatment of pelviureteric junction (PUJ) obstruction. RESULTS: In the PCNL group complete stone clearance was achieved in 68% (17/25) patients and the complication rate was 28% (7/25). In the endopyelotomy group the success rate of relief of obstruction of PUJ measured by renogram and relief of symptoms was 83% (5/6 patients). CONCLUSION: Our early results of PCNL are promising and comparable to international results.

Plastibell Circumcision: How Safe is it?: Experience at Sultan Qaboos University Hospital.

BACKGROUND: Plastibell circumcision complications can be life-threatening. OBJECTIVE: The aim of this paper is to review the complications of Plastibell circumcision reported in the literature and in our own patients to determine the safety of the procedure. METHOD: A retrospective study of 171 neonates circumcised in Sultan Qaboos University Hospital over a 4-year period from 1997 to 2000. RESULTS: Minor complications occurred in 4 (2.3 %) of circumcisions. Two cases were converted to formal circumcision due to bleeding and failure to introduce the bell respectively. One had delayed passage of urine for 24 hours and in one neonate, the parents were concerned about inadequate removal of foreskin. CONCLUSION: Plastibell circumcision is a safe technique in experienced hands. The risk of complications with this procedure is increased eight-fold when performed by nurses compared to surgeons.

Effects of cagA+ and cagA- strains of Helicobacter pylori on the human gastric mucus layer thickness.

BACKGROUND: Infection with cytotoxin-associated gene A (cagA) Helicobacter pylori is associated with severe gastric diseases, with contradictory views being expressed concerning the effect of H. pylori on the gastric mucus thickness. The aim of the present study was to differentiate between the effect of cagA+ and cagA- strains on gastric mucus thickness. METHODS: Ninety-nine patients without peptic ulcers who were not on medication were randomly recruited from consecutive endoscopy clinics: six biopsies (five antral, one body) were obtained from each patient. Cryostat sections (18 microm) were cut and stained using the modified periodic acid-Schiff/Alcian blue technique. Mucus thickness was measured using computer-assisted light microscopy. The H. pylori status was assessed by histology, Campylobacter-like organism (CLO)test and culture, and cagA+ status determined by polymerase chain reaction (PCR). RESULTS: There was no significant difference (P = 0.784) in mean mucus thickness between cagA+ (52.7 +/- 1.2 microm, n = 10), cagA- (46.6 +/- 1.1 microm, n = 18) or H. pylori-negative patients (51.3 +/- 1.1 microm, n = 30). In cagA- patients, mucus thickness was significantly reduced with increased H. pylori colonization density, Spearman (r(s)) = -0.805, P < 0.0001. In contrast, in cagA+ patients there was a weak positive, but not significant, association between mucus thickness and H. pylori colonization density, r(s) = 0.333, P = 0.381. CONCLUSIONS: The human gastric mucus thickness is not affected by infection with cagA+ or cagA- strains of H. pylori compared with uninfected. Although a trend of increased mucus thickness with cagA+ infection was observed.

Helicobacter pylori. Basics and clinical overview.

The discovery of Helicobacter pylori (H. pylori) has greatly changed the approach to the management of peptic ulcer disease and gastric cancer. A sound knowledge of the basics of H. pylori is an important aid in the diagnosis and treatment of clinical conditions associated with this infection. Gastric carcinoma is estimated to be the world's second most common cancer as a cause of death. It is hoped that gastric cancer can be prevented by H. pylori eradication; however, this issue is still under investigation. Active research is ongoing to highlight the mechanisms by which H. pylori leads to severe gastric diseases as well as finding associations with extra-gastric diseases.