A. I. A. Ibrahim

Cost-Effective Emergency Diagnosis Plan for Urinary Stone Patients Presenting with Ureteric Colic

Objective: To develop a cost-effective plan for the accurate diagnosis of urinary stone patients presenting with ureteric colic based on an assortment of investigations which are less invasive and more economical than intravenous urography (IVU). Patients and Methods: 143 consecutive emergency patients presenting with ureteric colic were admitted to hospital and prospectively studied by history recording, physical examination, laboratory tests and imaging procedures according to a preset format. Significant association of the final diagnosis of urinary stones (which was made by actual stone retrieval) with various diagnostic variables obtained from the results of investigation (including IVU) was statistically studied using bivariate correlation and multivariate logistic regression analysis. Algorithms for reaching an accurate diagnosis of urinary tract stones were formulated using the most significant diagnostic variables and the accuracy of each of those plans was compared with that of emergency IVU. Results: 18 patients were excluded for various reasons. Of the remaining 125 patients 82 (66%) were confirmed as having urinary stones. A positive IVU had the strongest correlation with the final diagnosis of urinary tract stones. Other findings associated with eventual stone retrieval in a descending order of significance were: calcular sonographic features; radio-opacities on a plain abdominal film of the kidney, ureter and bladder (KUB), and microhaematuria. Based on these findings two algorithms could be formulated to reach as accurate a diagnosis as possible. Algorithm A in which an initial ultrasound is mandatory had a sensitivity of 89%, a specificity of 88% and an overall accuracy of 88% for urinary stone detection compared with 91, 77, and 86%, respectively, for algorithm B in which ultrasonography was employed selectively after initial KUB and urinalysis for microhaematuria. This compares with 94, 79, and 89%, respectively, for IVU. Conclusion: Both plans are viable alternatives which could replace routine emergency IVU.

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.

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.

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.

Ultrasound Scanning in Scrotal Disorders: Correlation of Clinical and Operative Findings

Seventy-five patients presenting with or suspected to have a scrotal disorder were prospectively investigated by scrotal ultrasonography using a real-time ultrasound scanner with either linear (3.5...