Risk of Prostate Cancer in Chronic Kidney Disease Patient: A Meta-Analysis using Observational Studies.

Background: Both clinical and experimental findings demonstrated a rise in prostate cancer in chronic renal illness. However, the clinical data associated with CKD was not looked at the context of prostate cancer. The study aims to investigate prostate cancer risk in CKD patients using clinical data via systemic review and meta-analysis. Materials and Methods: Using pertinent pairing keywords, I carried out a thorough exploration of PubMed/MEDLINE and Web of Science. The pooled HR with 95% CI of the considered clinical findings was estimated involving the general inverse variance outcome type. With RevMan 5.3, the total pooled estimate meta-analysis was evaluated utilizing the random effects model. Results: Total of six findings were considered for this analysis, with a total of 2,430,246 participants. The age and mean follow-up of the included patients and studies ranged from 55 to 67.4 years and 10.1 to 12 years, respectively. The meta-analysis showed no significant risk of prostate cancer among CKD patients (HR: 0.92; 95% CI: 0.60-1.41; P = 0.70). The results from subgroup analysis based on eGFR levels ranged ≥30-59 ml/min per 1.73 m2 and also found no significant risk of prostate cancer among CKD patients (HR: 1.04; 95% CI: 0.92-1.18; P = 0.52). Here I did not report statistical heterogeneity found (Q = 0.56, I2 = 0%, P = 0.87). As per the Newcastle-Ottawa scale, the included studies suggested good quality. Conclusion: The results suggest no significant risk of developing prostate cancer among CKD patients. Therefore, well-designed prospective cohort studies with stages of CKD and clear predefined prior history and causative factors are needed to support the present evidence strongly.

Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study.

PURPOSE: To identify the rate of Peripherally Inserted Central Catheter (PICC) placement in patients with chronic kidney disease (CKD), stage 3B or higher (glomerular filtration rate (eGFR) <45 mL/min/1.73 m2). MATERIAL AND METHODS: A retrospective study of 2825 adult patients (male 51.2%, female 48.8%) who had a PICC insertion from January 2017 to December 2019. The data collected includes gender, eGFR value at the date of insertion, accessed vein and side, ongoing or subsequent dialysis within 1 year, and death within 1 year of the insertion date. The study excluded pediatric patients, patients with missing eGFR values prior to the procedure and follow-up information. RESULT: PICC insertion was done in patients with eGFR⩽45 mL/min/1.73 m2 in 26.7% (724/2709) of the sample. Ongoing dialysis was documented in 10.2% (198/1946) and subsequent dialysis in 6.5% of the patients within the year after insertion. The overall death rate for the year post PICC insertion was 38.7% (1094/2825), which was significantly higher in low eGFR patients (413/724, 57%) compared to patients with eGFR>45 mL/min/1.73 m2 (632/1985, 31.8%) (p-value < 0.0001, odds ratio 2.84 (95% confidence interval 2.38-3.38)). The rate of dialysis initiated in the year post PICC insertion was 5.9% (98/1657). This was significantly higher in patients with a low eGFR and not previously dialyzed (59/310, 19%) compared to patients with eGFR>45 who required dialysis in the year post insertion (39/1347, 2.9%) (p < 0.0001, odds ratio 7.88 (95% confidence interval 5.14-12.07)). CONCLUSION: PICC insertion in patients with CKD is practiced frequently. Rigorous strategies should be implemented to improve adherence to clinical practice guidelines and reduce unnecessary insertions and preserve veins for when an AVF may be required.

Is survival after radical cystectomy for bladder cancer in Saudi patients different from that of Western patients?

BACKGROUND: Although radical cystectomy (RC) is considered the gold standard treatment of muscle invasive bladder cancer, nearly half of patients develop metastases and ultimately die within 2 years. OBJECTIVE: To assess survival, evaluate different prognostic factors that may affect disease-free survival (DFS) in Saudi patients after RC for carcinoma of the bladder and to compare our results with those of Western countries. DESIGN: Retrospective chart review. SETTING: A tertiary care center in Saudi Arabia. PATIENTS AND METHODS: We collected data on patients who underwent RC for bladder cancer in the period between 1979 and 2014. Demographic, clinical and pathological variables and the application of perioperative chemotherapy were reviewed. Univariate and multivariate analyses were done with DFS as the end point. MAIN OUTCOME MEASURE: Disease-specific survival. RESULTS: On 328 patients for whom data was available, the median follow up was 23 months (range, 2 month-28 years) and median age was 58 years (range, 21-90). Of these patients, 268 were males (81.7%), 235 (71.7%) had urothelial carcinoma (UC), 79 (24.1%) had squamous cell carcinoma (SCC), and 208 (63.4%) had pathological tumor stage 3 or more. The 5-year overall survival (OS) and DFS were 52% and 48%, respectively. There was no statistically significant difference in DFS of patients with UC and pure SCC. On univariate analysis, lymph node status and pathological tumor stage were significant predictors of DFS. Both variables sustained statistical significance in a multivariate analysis. CONCLUSION: Survival following RC is almost the same as others. Moreover, pathological tumor stage and lymph node metastasis were the only independent predictors for survival following RC. Future cooperative prospective studies are required to gain data on our region. LIMITATIONS: Relatively small sample size and retrospective.

Management of Patient Flow in Vascular and Interventional Radiology During MERS-CoV Outbreak.

In 2015, an outbreak of Middle East respiratory syndrome coronavirus occurred in Saudi Arabia and necessitated special measures to be implemented to control the spread of the virus. In this article, we will discuss how the outbreak was managed in the vascular and interventional radiology (VIR) suite in a large tertiary care hospital in Saudi Arabia. Various measures were taken to reduce the risk of transmission of infection. Unit-level education played an important role in the care of patients. A hospital-wide educational program was implemented to ensure zero transmission of infection. Special attention was made to monitor staff who acquired the virus. VIR suite was able to handle the situation and control the outbreak.

Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated patients.

BACKGROUND: Maintaining the cuff pressure of endotracheal tubes (ETTs) within 20-30 cmH2O is a standard practice. The aim of the study was to evaluate the effectiveness of standard practice in maintaining cuff pressure within the target range. METHODS: This was a prospective observational study conducted in a tertiary-care intensive care unit, in which respiratory therapists (RTs) measured the cuff pressure 6 hourly by a handheld manometer. In this study, a research RT checked cuff pressure 2-4 h after the clinical RT measurement. Percentages of patients with cuff pressure levels above and below the target range were calculated. We identified predictors of low-cuff pressure. RESULTS: We analyzed 2120 cuff-pressure measurements. The mean cuff pressure was 27 ± 2 cmH2O by the clinical RT and 21 ± 5 cmH2O by the research RT (p < 0.0001). The clinical RT documented that 98.0 % of cuff pressures were within the normal range. The research RT found the cuff pressures to be within the normal range in only 41.5 %, below the range in 53 % and above the range in 5.5 %. Low cuff pressure was found more common with lower ETT size (OR, 0.34 per 0.5 unit increase in ETT size; 95 % CI, 0.15-0.79) and with lower peak airway pressure (OR per one cm H2O increment, 0.93; 95 % CI, 0.87-0.99) on multivariate analysis. CONCLUSIONS: Cuff pressure is frequently not maintained within the target range with low-cuff pressure being very common approximately 3 h after routine measurements. Low cuff pressure was associated with lower ETT size and lower peak airway pressure. There is a need to redesign the process for maintaining cuff pressure within the target range.

Robotic extramucosal excision of bladder wall leiomyoma.

INTRODUCTION: Multiple case reports and reviews have been described in the literature for bladder wall leiomyoma resection via different approaches. The minimally invasive partial cystectomy remains the most widely accepted technique; however, case reports for enucleation of bladder wall leiomyoma have also been described. The purpose of this video is to demonstrate the robotic extramucosal excision of a bladder wall leiomyoma, without cystotomy, but with complete removal of the muscular layer. MATERIALS AND METHODS: A 35-year old male present with lower urinary tract symptoms and imaging showed bladder wall mass with histopathology showed leiomyoma. The patient consented for mass excision with the possibility of a partial cystectomy. The patient was placed in the supine, 30-degree Trendelenburg position during the procedure. A total of 4 ports were inserted. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. Extramucosal excision was accomplished without cystotomy and muscle approximation was achieved by 2 0 Vicryle. RESULT: The operative time was 90 minutes, blood loss of approximately 50mL and the patient was discharged after 72 hours with no immediate complications and a 6 months follow-up showed no recurrence. CONCLUSION: Such a technique results in complete excision of the tumor, without cystotomy, and also maintains an intact mucosa. These steps, in addition to decreasing the risk of local recurrence, also shorten the period of postoperative catheterization and hospitalization.

Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses.

OBJECTIVE: The aim of this study was to identify predictors of viable germ cell tumor (GCT) in postchemotherapeutic residual retroperitoneal masses. MATERIALS AND METHODS: The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection (PC-RPLND) at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT. RESULTS: Out of the 16 male patients, 2 (13%), 8 (50%), and 6 (37%) had viable GCT, fibrosis, and teratoma, respectively. Ten (10) of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers. CONCLUSION: None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with ≥S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this.

Pattern of management of urologic cancer in Saudi Arabia.

BACKGROUND: To compare the current uro-oncologic practice pattern in Saudi Arabia with the standard of care practice and to identify obstacles in our health care system that prevent offering such a treatment. MATERIALS AND METHODS: We surveyed 247 practicing urologists in Saudi Arabia using a designed questionnaire. This questionnaire contains 19 questions focusing on management of bladder and renal cancers. RESULTS: Of the 247 contacted urologists, 86 completed the questionnaire. Seventy six percent see more than 10 bladder cancer cases/year and 83% used rigid cystoscope for diagnosis under general anesthesia. Eighty two percent perform over 10 bladder tumor resections/year; however, 90% of them perform less than five cystectomies/year, if any. Seventy nine percent had intravesical therapy available at their hospitals and majority of them use it after resection in selected patients. Fifty percent preferred re-resection within 2-4 weeks for T1 and/or G3 tumors and majority of them (86%) perform cystectomy for muscle invasive disease and ninety six percent perform ileal conduit. Thirty four percent see over 10 renal cancers/year. Forty nine percent perform radical nephrectomy for less than 4 cm renal masses and for more than 4 cm, only 9% do laparoscopic nephrectomy while the majority preferred open technique although 77% of the hospitals participated in this survey have a urologist capable of doing laparoscopy. CONCLUSION: A significant number of urologists in Saudi Arabia do not apply some of the well-accepted standard practices in urologic cancer. To improve this, we need to work on our referral system and establish education and training programs to make the urologist familiar with the new modalities of treatment.

Robotic augmentation enterocystoplasty.

Augmentation enterocystoplasty is an established procedure performed to increase bladder capacity and reduce intravesical pressure in patients with neurogenic bladder. Although the open surgical procedure remains the most widely accepted technique, laparoscopic enterocystoplasty has been described. As an extension of the minimally invasive approach, we describe a technique for robotic augmentation enterocystoplasty with a completely intracorporeal method. To our knowledge, this is the first report of such a technique.

Laparoscopic ablation of giant renal cyst.

We report a case of a symptomatic giant (18 x 10 x 8-cm) renal cyst in a 40-year-old woman that was marsupialized laparoscopically and excised. The surgical technique, based on progressive decompression of the cyst, is fully described. Excellent results were achieved. The recent application of laparoscopic ablation of different types of renal cysts is reviewed. This minimally invasive technique, when properly mastered, is highly effective and offers results similar to those of open surgery. It is associated with definitive postoperative advantages and is the treatment of choice for very large renal cysts, especially those located anteriorly, when sclerotherapy is ineffective or is contraindicated.