Bilharzial and nonbilharzial bladder cancer in Asir: A comparative clinicopathological study.

A total of 48 bladder cancer patients out of 96 consecutive genitourinary cancer cases were divided into bilharzial and nonbilharzial groups on a histological basis in order to investigate the impact of bilharziasis on tumor behavior. Despite being a bilharzial endemic area, only 10/48 (21%) of our patients had bilharzial cancer (BC) of whom 8 (80%) had squamous cell carcinoma (SCC) and 2 (20%) had adenocarcinoma. Out of 38 patients with nonbilharzial cancer (NBC), 35 (92%) had transitional cell carcinoma (TCC), and 3 (8%) had SCC. BC in males presented at a younger age than NBC (P<0.05). All ten patients with BC presented with deeply invasive (T3 and T4) tumors as compared to 22/38 (58%) with NBC (P<0.05). Comparison of clinical and laboratory features in both groups in both groups did not reveal any significant difference. We conclude that in the Asir region, TCC is the most common bladder cancer. However, with bilharziasis, bladder cancer tends to be of the squamous type and presents at an earlier age and at an advanced stage.

Is intravenous urography mandatory in the management of benign prostatic hyperplasia?

Fifty-four consecutive patients with uncomplicated benign prostatic hyperplasia (BPH) underwent intravenous urography (IVU) and ultrasonography (US) to observe the benefits of IVU over US. The parameters used were upper tract abnormalities detected on both modalities and the influence of radiological prostatic impression (RPI) on the route of surgery and its comparison to digitally estimated prostatic size (DEP). Both RPI and DEP were compared to the adenoma weight (AW). Correlation of RPI and DEP was excellent (87.5%) in grade III but poor in grades I and II. RPI and AW correlated well in grade III (100%) and was also significant in grades I and II, whereas DEP correlated well with AW in all grades. Both RPI and DEP could predict the route of prostatectomy accurately in grades I and III, whereas in grade II, RPI was marginally better in predicting the route. There was no upper tract abnormalities that were detected on IVU and missed by US. In conclusion, IVU did not add any additional information beyond that obtained by rectal examination and US to alter the surgical approach and hence the routine use of urography in uncomplicated BPH should be questioned in Saudi Arabia.

Specific investigations in chronic urinary bilharziasis.

Seventy-two patients with histologically confirmed chronic urinary bilharziasis were studied for the reliability of some specific investigative tools in diagnosing this disease, namely urinalysis, serology, urography, and cystoscopy. Of the 72 patients 36 (50%) had hematuria and only 3 (4%) had ova of Schistosoma haematobium on urinalysis. Sixty-two patients (86%) had features of bilharziasis on intravenous urography (IVU). Of the remaining 10 patients with negative urography 6 underwent serology and all had positive results. Of the total patients 52 underwent serology and 49 had significant bilharzial antibody titer (94.2%). At cystoscopy all patients (100%) had features of bilharziasis. It is concluded that the most reliable diagnostic tools in chronic urinary bilharziasis are cystoscopy, serology, and to a lesser extent urography. Unlike early bilharziasis, chronic bilharziasis can be missed if total reliance is placed on urinalysis for screening a population at risk.

Bilharzial vesicoureteric reflux and bladder neck stenosis: fact or fiction?

A group of 47 patients with histologically confirmed chronic urinary bilharziasis underwent micturating cystourethrography to look for vesicoureteric reflux (VUR) and bladder neck stenosis (BNS); 13 patients were found to have VUR of varying grades (8 unilateral and 5 bilateral). None had evidence of BNS. Urinary tract infection (UTI), loin pain, hydroureter and renal failure were compared in patients with and without VUR. Of the 13 patients with reflux, 3 had UTI, loin pain was present in 8, 11 had an ipsilateral hydroureter and 2 presented with renal failure. In the 34 patients without reflux, 8 had UTI, loin pain was present in 22, 30 had hydroureter and 3 presented with renal failure. It was concluded that the incidence of UTI, loin pain, hydroureter and renal deterioration associated with bilharzial VUR was not significantly different from that found in bilharzial patients without VUR. Thus the clinical significance and the need for surgical correction of isolated VUR in bilharziasis are questionable.

Role of Franzen needle aspiration biopsy in carcinoma of the prostate.

A retrospective study is reported of all Franzen fine-needle aspiration cytology undertaken at Southmead Hospital between January 1978 and December 1981. A total of 1043 aspirates were examined from 753 patients. The diagnosis of carcinoma of the prostate was missed in 2 patients. Twenty-one patients with cytologically-proven carcinoma in histologically-benign prostates were detected, and the role of the Franzen needle in the diagnosis of early prostatic cancer is discussed. Of the 218 patients proceeding to prostatectomy, there were 91 patients with carcinoma and in 65 (72%) the cytological and histological grading was identical. A significant disparity occurred in 8 cases and the reasons are discussed.