Ureteric injuries during obstetric and gynecologic procedures.

OBJECTIVE: To review the ureteric injuries resulting from obstetric and gynecologic procedures with a comparative analysis of current pertinent literature. METHODS: From January 1994 -December 1997, the medical records of all patients who sustained ureteric injuries as a result of obstetric or gynecologic procedures and managed at the Princess Basma Teaching Hospital, North of Jordan were reviewed. The clinical presentations, investigations, features of injury and treatment modalities were studied. RESULTS: There were 17 patients with 19 ureteric injuries incurred during obstetric or gynecologic procedures during the study period. Patients were relatively young and presented with loin pain. The left lower ureter was injured in 11 cases. Hysterectomy, alone, accounted for 13 injuries mainly in association with malignancy. Deliveries, in general, were associated with very low rate of injury. Ureteric ligation was the most common mechanism of injury (47%). Injuries were intraoperatively recognized in 41.2% (7/17) of cases. Patients were treated by either endourological or formal surgical repair. The overall success rate after an average of 32.3 months of follow-up was achieved in 89.5% (17/19). This outcome was not significantly altered by either the features of injury or by the treatment schedules. CONCLUSION: Iatrogenic ureteric injury is still a major cause of harm and concern. The time taken to detect the injury remains the most important morbidity-related factor. Recent trends towards earlier intervention and the use of various endourological means of repair deserve support and promotion.

Cryptorchidism and testicular neoplasia.

OBJECTIVE: Traditionally there is a concern about the possibility of developing testicular tumors as a consequence of undescended testis. This study was conducted to investigate the correlation between testicular tumors and undescended testis. METHODS: Medical records of all patients with testicular germ cell cancer were seen and examined at the Princess Basma Teaching Hospital, Jordan University of Science and Technology, Irbid, Jordan, between 1990 and 2000 (group 1) for any evidence of undescended testis. All males with undescended testis attending the infertility clinic during the period 1999-2001 (group 2) were re-evaluated for any evidence of testicular tumors. The operative records of all patients who had surgery for undescended testis during the past 30 years (group 3) were reviewed and the patients were contacted to see if any of them developed testicular tumor as expected. RESULTS: Forty-four patients with testicular germinal cell tumors; mean age at diagnosis were 32.6 years (range 20-50) were identified. All patients had unilateral involvement and none of them were found to have tumors in undescended testis. The tumor was in the scrotum in all patients. None of the 117 infertile patients with undescended testis had clinical or ultrasonic evidence of testicular tumors. Two thousand nine hundred and nineteen patients had an operation for undescended testicle in the past 30 years, average of 97.3 operations annually. Median age at surgery for undescended testis was 7.7 years (range 2-29 years). None of the 2071 patients who were traceable developed testicular tumor. CONCLUSION: We found no evidence to support that patients with undescended testis are at a higher risk than the general population to develop testicular cancer.

Detection, staging and clinical implications of renal cell carcinoma.

OBJECTIVE: To compare the epidemiologic, clinical, and pathologic characteristics of symptomatic and incidental renal cell carcinoma (RCC) in Jordan, with some emphasis on age distribution and its potential effect in defining groups of patients that may benefit from early detection programs. We compared our results with the published western figures. METHODS: Records of 119 patients with renal tumors diagnosed during the period January 1992 to December 2001 at Jordan University of Science and Technology, Irbid, Jordan were reviewed. Age, gender, discovery circumstances of the tumor, radiologic and biologic workup, treatment, tumor node metastasis classification, and histologic features of the tumor were analyzed. RESULTS: The mean patient age was 54, and the male to female ratio was 3.4:1. The annual frequency rate for RCC per 100,000 population was 1.2 for both sexes, while for men was 1.8 and for women was 0.5. Twenty-six percent of tumors were discovered accidentally. The mean age at the time of diagnosis was not influenced by the discovery circumstances. The incidental detection group had significantly small size of tumor (5.6 cm circumference (c.f) 8.1 cm), lower stage and lower histological grading. In the symptomatic group; women have significantly lower mean size of tumors than men (5.5 cm c.f. 7.7 cm; p = 0.005; t-test), while there is no significant difference among the incidental group. A radical nephrectomy was performed in 92% of the cases, and in 8% of the cases, conservative management was adopted. CONCLUSION: The present study showed that the incidence rates of RCC in Jordan and other Middle East countries were less than most of the western countries. Malignant renal tumors in Jordan tend to affect people at a remarkably young age. This is mostly a reflection of the high proportion of young people in this country. This high portion of young people may explain the low incidence as kidney cancer is known to increase with age. Significant numbers of RCC were detected incidentally with lower pathological stage and grade. Subsequently these clinically and histologically less aggressive lesions lead to better survival and decreased recurrence. These data efforts should be directed to the development of a screening protocol to detect these lesions early, so that they may be prevented from progressing to the point when symptoms are apparent and prognosis becomes worse.

Retroperitoneal fibrosis. Demographic, clinical and pathological findings.

OBJECTIVE: To describe the clinical characteristics of patients with retroperitoneal fibrosis including the etiopathogenesis, clinical features, diagnostic criteria and effective treatment of the disease. METHODS: This study was carried out at Princess Basma Teaching Hospital, Irbid, Jordan, during the year 2001. Records of 15 patients with retroperitoneal fibrosis were retrospectively reviewed. Demographic, clinical and pathological criteria was evaluated and analyzed. RESULTS: From 1990 to 2000, there were 15 patients seen with retroperitoneal fibrosis (10 men and 5 women; the mean age was 55.8 years, ranging between 39 years to 75 years). Nine cases were idiopathic and 6 were secondary. Risk factors of the idiopathic group were cigarette smoking (6 patients) and arterial hypertension (4 patients). Etiologic factors of the secondary group were aortic abdominal aneurysm (3 cases including one following abdominal aortic surgery), radiation therapy for seminoma (one case), ergot-derivative treatment (one case), retroperitoneal non-Hodgkin lymphoma (one case). Main presentations were abdominal or back pain, or both. Treatment performed was medical in 5 cases, medical and endourological in 3 cases and 7 patients received surgical treatment. Medical treatment induced remission in 3 patients, while endourological and surgical treatment resulted in complete recovery in 9 patients (including the 2 patients who failed medical treatment). In the remaining 3 patients treatment failed and the disease relapsed. CONCLUSION: Awareness of this rare disorder is important to prevent misdiagnosis. Retroperitoneal fibrosis remains a difficult therapeutic challenge. Aggressive medical, endourological or surgical treatment, or both are equally good modalities for its treatment.

Zinc in normal and pathological human prostate gland.

OBJECTIVE: This study is conducted to detect quantitatively zinc in the nuclei and cytoplasm of epithelial cells of the prostate from normal, acute prostatitis, benign prostatic hyperplasia and adenocarcinoma. METHODS: Prostatic tissues from normal, acute prostatitis, benign prostatic hyperplasia and adenocarcinoma were obtained from patients and processed for zinc detection using x-ray microanalysis technique. The samples were collected over a period of 2-3 years and were processed at Jordan University of Science and Technology, Irbid, Jordan. RESULTS: Zinc was increased and decreased both in the nuclei and the cytoplasm of the glandular epithelium of benign prostatic hyperplasia and adenocarcinoma of the prostate. Although zinc was increased in the nuclei and cytoplasm of epithelial cells of acute prostatitis, it was not significant. CONCLUSION: These findings might be caused by factors affecting the zinc metabolic pathway directly or through the zinc bound protein metallothionein. In addition, these findings could be used in diagnosing different prostatic pathological conditions and advancing prostatic tumors and those with similar histopathological profiles.