Ahmed Elabbady

Safety of no bowel preparation before ileal urinary diversion

Study Type – Harm (case series)

Free/total PSA ratio can help in the prediction of high gleason score prostate cancer in men with total serum prostate specific antigen (PSA) of 3-10 ng/ml.

Purpose We evaluate the use of free/total prostate specific antigen (PSA) ratio in improving the prediction of cancers of higher Gleason scores. Patients and methods A total of 164 patients with total serum PSA of 3.0–10.0 ng/ml underwent extended TRUS-guided core biopsy. In each man serum free PSA was measured and the free/total (F/T) PSA ratio was calculated. Out of the 164 patients who underwent TRUS-biopsy, cancer was detected in 62 (37.8%) patients. The mean age for the 62 patients with histologically proven prostate cancer was 62.3 ± 5.5 years (49–73). The histological findings were compared with the free/total PSA ratio. Pearson Correlation Coefficient test and Chi-Square test (χ2-test) were used for statistical analysis and p < 0.05 was considered statistically significant. ResultsOf the 62 patients, 37 (59.7%) patients had cancers of low Gleason scores (score 2–6) and 25 (40.3%) patients had cancers of high Gleason scores (score 7–10). Free PSA < 0.15% was found in 19 (30.6%) patients, from 15 to 20% in 23 (37.1%) patients and > 20% in 20 (32.3%) patients. There was a significant positive correlation between total PSA and Gleason score (Pearson Correlation Coefficient test, r = 0.328, p < 0.01). Also, there was a significant increase in Gleason score with lower F/T PSA ratio (r = −0.668, p < 0.001). Among the 19 patients with free PSA ratio < 15%, 14 (73.7%) patients had cancers of high Gleason score while 5 (26.3%) patients had cancers of low Gleason score. In patients (n = 23) with free PSA ratio15–20%, 10 (43.5%) had cancers of high Gleason score and 13 (56.5%) had cancers of low Gleason score. In the 20 patients with free PSA ratio > 20%, 1 patient (5%), had prostate cancer of high Gleason score and the remaining 19 (95%) patients had low Gleason scores. There was a significant relation between lower F/T PSA ratios and higher Gleason scores, Chi-Square test, χ2 = 19.3, p < 0.01. Conclusions In this study, men with prostate cancer and lower F/T PSA ratio were at a higher risk of having higher Gleason scores (7–10) and those with higher F/T PSA ratio were more likely to have lower Gleason scores.

Prognostic Factors for the Development of Biochemical Recurrence after Radical Prostatectomy

Prostate cancer is one of the most common cancers in Western countries and is associated with a considerable risk of mortality. Biochemical recurrence following radical prostatectomy is a relatively common finding, affecting approximately 25% of cases. The aim of our paper was to identify factors that can predict the occurrence of biochemical recurrence, so the patient can be properly counselled pre- and postoperatively. Medline review of the literatures was done followed by a group discussion on the chosen publications and their valuable influence. Preoperative serum total PSA and clinical stage, together with prostatectomy Gleason grade, tumour volume, and perineural and vascular invasions, were the most important variables found to influence outcome.

Percutaneous silicon catheter insertion into the IVC, following percutaneous nephrostomy (PCN) exchange

Percutaneous nephrostomy (PCN) has been widely used to drain an infected, obstructed kidney. Few major complications have been associated with it. Few publications have reported the misplacement of nephrostomy tube into the inferior vena cava (IVC), following percutaneous nephrolithotomy. We report a case of a misplaced silicon catheter, through the left renal vein, extending into the IVC, following nephrostomy tube exchange. Our case was safely managed, and we concluded that although PCN and nephrostomy tube exchange are relatively simple procedures, they should be done cautiously, by a well-trained urologist, and preferably under ultrasound or fluoroscopic guidance.

Fosfomycin antimicrobial prophylaxis for transrectal ultrasound-guided biopsy of the prostate: A prospective randomised study.

Abstract Objectives: To compare the incidence of infectious complications after single-dose fosfomycin vs. standard fluoroquinolone (FQ)-based prophylaxis in patients undergoing transrectal ultrasound-guided biopsy of the prostate (TRUSBx), as there is an alarming trend worldwide of increasing resistance to FQs limiting their suitability as appropriate prophylaxis for TRUSBx. Patients and methods: A prospective study was conducted in 412 consecutive patients undergoing TRUSBx between February 2012 and June 2015. Patients were randomly divided into two groups; Group 1 (202 patients) who received single-dose fosfomycin (3 g, orally) 1–2 h before TRUSBx and Group 2 (210 patients) who received routine empirical prophylaxis in the form of oral ciprofloxacin 500 mg and metronidazole 500 mg at least 1 h before TRUSBx and continued this twice daily for 3 days before TRUSBx. We recorded all febrile and afebrile urinary tract infections (UTIs) within the 4 weeks after the procedure. Results: There was no difference in baseline demographics between the two groups. Total infectious complications occurred in four (1.9%) and 18 (8.5%) patients in Groups 1 and 2, respectively, which was statistically significant (P = 0.001). Escherichia coli was the most common isolated pathogen from urine cultures in all patients with infectious complications (68%). The other isolated bacterium, Klebsiella pneumoniae, was detected in four patients (18%). Urine cultures revealed FQ-resistant strains (73%), all of which were extended-spectrum β-lactamase-producing E. coli and K. pneumoniae. Conclusions: Single-dose fosfomycin before TRUSBx significantly reduces infectious complications when compared with standard therapy. Fosfomycin is an effective agent for antimicrobial prophylaxis in patients undergoing TRUSBx, particularly in populations where FQ resistance is common.

Unusual presentations of prostate cancer: A review and case reports.

Abstract Objective: To report our institutional experience with some rare presentations of prostate cancer, as prostate cancer is a common problem and affects a large group of men during their lifetime, but a few studies report unusual presentations of metastatic prostate cancer. Methods: All possible clinical and pathological data were collected for six relevant patients with prostate cancer and unusual metastases who were identified at our institution. PubMed was searched for unusual presentations of prostate cancer in the last 20 years (1982–2012) and all relevant publications were assessed. The authors discussed the reports and selected those articles of major clinical significance to include in a review. Results: We identified 19 reports of major clinical significance and reviewed them. As in the cases from our institution, supraclavicular lymphadenopathy, isolated upper ureteric obstruction and severe obstructing constipation were some of the rare presentations encountered at other institutions, and reported mostly as sporadic case-reports. Conclusion: Prostate cancer should be always considered in the differential diagnosis of elderly men presenting with supraclavicular lymphadenopathy, hydroureteronephrosis or constipation, even in the presence of a normal digital rectal examination and low serum total prostate-specific antigen (PSA) levels. PSA immunohistochemical staining should be used in doubtful cases.

Clinical experience with shock-wave lithotripsy using the Siemens Modularis Vario lithotripter

Abstract Purpose: To assess the effectiveness of a lithotripter (Modularis Vario; Siemens, AG Healthcare, Munich, Germany) in the management of renal and ureteric stones. Patients and methods: In all, 1146 adult patients with renal or ureteric stones were treated at one urological centre using the latest model of the Modularis Vario lithotripter. The effectiveness of lithotripsy and re-treatment rate were assessed. Data were obtained on stone location, stone size, shock wave usage, success rate, and complications. Results: Between May 2007 and November 2009, 698 patients with renal stones and 448 with ureteric stones underwent extracorporeal shock-wave lithotripsy (ESWL). The mean (SD) renal stone size was 12.8 (3.8) mm; a mean of 1.36 sessions was required, with a mean (SD) number of 3744 (1961) shocks delivered per renal stone. After 3 months, the success rate defined as the patient being stone-free or with residual fragments of <4 mm; for renal stones the rate was 91.1%, with a 6.9% complication rate in the form of steinstrasse and severe renal colic. The mean (SD) ureteric stone size was 10.4 (2.7) mm. A mean of 1.37 sessions was required, with a mean (SD) of 4551 (2467) shocks delivered for each ureteric stone. The success rate for ureteric stones was 89.5%, with a 5.6% complication rate. The overall efficiency quotient was 0.66. Conclusion: The Siemens Modularis Vario lithotripter is a safe and effective machine for treating renal and ureteric stones.

Pattern of prostate cancer presentation among the Egyptian population: A study in a single tertiary care center.

Introduction Prostate cancer is a common health problem that in the majority of cases starts to develop at the age of 50 years, reaching its peak at 60–70 years of age. A variation in its incidence and prevalence exists between western, Asian and Arabic populations. The aim of our work was to report the pattern of prostate cancer presentation in Alexandria University that as a tertiary referral center provides care for uro–oncology cases. Material and methods Data collection for all patients diagnosed with prostate cancer at Alexandria University in Egypt through the year 2012 was done. Results The mean age of the patients was 67. Mean serum total PSA, prostate volume and PSAd were 149 ng/ml, 63 grams and 3.1 ng/ml/gm respectively. 25% of patients were asymptomatic diagnosed accidentally during screening for prostate cancer. The remaining group was presenting with LUTS, including 23 patients who presented initially with back pain. Conclusions Egyptian men with prostate cancer have a markedly high PSA density and Gleason grade at diagnosis.

MP13-14 STUDYING THE EFFECT OF DIABETES MELLITUS TYPE 2 ON PROSTATE RELATED PARAMETERS: A PROSPECTIVE SINGLE INSTITUTIONAL STUDY.

an increased risk of lower urinary tract symptoms (LUTS) relative to daytime workers, and are also at increased risk for shift work sleep disorder (SWSD), a primary circadian rhythm disorder indicated by excessive daytime sleepiness associated with shiftwork. Here we examine the association between SWSD and LUTS in shift workers. METHODS: Men presenting to a single andrology clinic between July 2014 and September 2016 completed questionnaires that assessed work schedule, SWSD risk, and LUTS (International Prostate Symptom Score (IPSS)). The impact of non-standard shift work and SWSD on IPSS score was assessed using ANOVA and linear regression. RESULTS: Of the 2,487 men who completed the questionnaires, 766 (30.8%) reported working non-standard shifts in the past month. Of these, 282 (36.8%) were diagnosed with SWSD. Cohort characteristics are described in Table 1. When controlling for age, comorbidities (via the Charlson Comorbidity Index), and testosterone (T) levels, non-standard shift work was not associated with worse LUTS (P1⁄40.99). However, non-standard shift workers diagnosed with SWSD had IPSS scores 3.1 points higher than non-standard shift workers without SWSD (P<0.0001). CONCLUSIONS: Non-standard shift workers diagnosed with SWSD have worse LUTS than those without SWSD, suggesting that poor sleep habits, rather than shift work itself, contribute to worse LUTS. Modification of work and sleep schedules may reduce the risk for SWSD and subsequent LUTS.

The value of extended good quality transurethral resection of bladder tumour in the treatment of the newly diagnosed bladder cancer

Abstract Objective: To report our experience for the initial management of patients with newly diagnosed bladder tumours using our team approach for each case and using an aggressive extended transurethral resection of bladder tumour (TURBT) in order to investigate the real need for a routine ‘second-look’ cystoscopy in the current era. Patients and methods: The study included 50 consecutive patients admitted to the urology department, of our tertiary care centre, for management of newly diagnosed bladder cancer. Exclusion criteria included past history of bladder tumour, palpable mass on bimanual examination under anaesthesia, presence of residual tumour at the end of resection, and patients with tumours of the bladder dome as thorough resection is difficult to achieve in this area without an attendant risk. Patients that had pathologically confirmed carcinoma in situ were also excluded. White-light cystoscopy was used in all of the cases. Extended TURBT was defined as resection of the whole tumour, resection of the tumour base and 1 cm of apparently normal bladder wall around the circumference of the tumour. Results: The median (range) age of the patients was 52 (39–60) years. After initial TURBT, 10 patients (20%) were identified as having muscle-invasive bladder cancer. Of the remaining 40 patients, three had low-grade Ta disease, and so second biopsies were not taken. The remaining 37 patients had T1, grade 2–3 disease and none of them had evident residual disease at the site of tumour resection. Conclusion: Re-staging TURBT could be safely omitted for select groups of patients. An experienced surgeon and teamwork, together with an extended TURBT can accurately achieve complete tumour resection, with accurate tumour staging, on initial resection.