M.A. Atta

Changing Age Incidence and Pathological Types of Schistosoma-Associated Bladder Carcinoma

PURPOSE The changes in certain characteristic features of schistosoma-associated bladder carcinoma are determined. MATERIALS AND METHODS A retrospective study was done of patients with schistosoma-associated bladder carcinoma treated between 1962 and 1967, and between 1987 and 1992. RESULTS Mean patient age increased from 47 +/- 13.6 to 53 +/- 12.2 years and the male-to-female ratio changed from 7.8:1 to 4.9:1. Tumors showed a decreased incidence of nodular (58.7% versus 83.4%) and squamous (54% versus 65.8%) cell types, and an increased incidence of papillary (34.8% versus 4.3%) and transitional (42% versus 31%) cell types. All changes were statistically significant (p < 0.05) and paralleled by an increased incidence of low degree schistosomal infestation from 18.6 to 47.8% (p < 0.05). CONCLUSIONS The shift in age incidence and pathological findings towards those of nonschistosomal cases could conceivably be attributed to the increased incidence of low infestation in recent years. The change in male-to-female ratio is probably due to more exposure of women to schistosomal infestation than has occurred previously.

A New Technique for Ileal Nipple Fixation: Preliminary Report

A new technique for ileal nipple fixation is described in 6 post-cystectomy patients (4 with an ileal bladder substitute and 2 with an ileal reservoir) for the prevention of reflux. Nipple formation is helped by deperitonealization and defatting of the nipple mesentery. A full circumferential incision is made, except for the mesenteric border, and through both nipple layers down to the mucosa of the inner layer. The seromuscular layers on each side of the incision are closed together with continuous 3-zero polyglycolic acid suture. The overlying outer mucosa of both edges then is closed. Endoscopic and radiographic study 6 to 12 months postoperatively showed a stable nipple without reflux. The anatomical and physiological rationale of the technique is discussed.

Recurrence pattern in patients with locally advanced renal cell carcinoma: The implications of clinicopathological variables.

Abstract Objectives: Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence. Patients and methods: We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3–T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Univariate and multivariate analyses were conducted. Results: Patients were followed for a mean and median follow-up of 33 and 24 months, respectively, after surgery. During the follow-up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged <70 years, symptomatic at presentation, with larger tumours, higher nuclear grade, collecting-system invasion, and/or sarcomatoid differentiation. After multivariate analysis, T-stage, nuclear grade and sarcomatoid differentiation retained their power as independent predictors of RFS (P = 0.032, <0.001 and 0.003, respectively). Conclusions: For patients with LARCC, T-stage, grade and sarcomatoid differentiation independently dictate the risk of tumour recurrence. Considering these variables in the postoperative surveillance protocols and in the need for a multimodal therapeutic approach is highly recommended.

Clinical evaluation of patients treated with a detubularised isolated ureterosigmoidostomy diversion after radical cystectomy.

Abstract Objectives: To assess the emptying pattern and patient satisfaction after constructing a detubularised isolated ureterosigmoidostomy (DIUS) following a cystectomy, introduced to overcome the poor outcome of conventional ureterosigmoidostomy, to improve the emptying pattern and accordingly patients’ quality of life. Patients and methods: The study included 122 patients who were treated with a DIUS diversion after cystectomy. The minimum follow-up of the patients was 6 months. The frequency of emptying and continence during the day and night were recorded. The ability of the patients to discriminate between urine and stool was assessed. The patients’ overall satisfaction with the outcome was categorised as fully satisfied, moderately satisfied or not satisfied. Results: In all, 95 patients were available for this evaluation; all patients were completely continent during the day and night. The mean emptying frequency was 3.9 during the day and 1.7 during the night. All patients were able to feel the desire to empty and the mean holding time was 35 min. Fifty-two patients (55%) could pass solid stools once per day, with minimal urine at the end of voiding, and the remaining evacuations were of clear urine only. Thirty-two patients (34%) were able to differentiate between urine and stool sensation before emptying. For satisfaction, 82 patients reported full satisfaction, 13 were moderately satisfied, and none regretted the diversion. Conclusions: The DIUS diversion provides continence during the day and night, with a satisfactory emptying habit. Patients with a DIUS diversion can tolerate a full pouch comfortably, with no leakage, and they can discriminate between urine and stool evacuations.

The embedded nipple: An optimal technique for re-implantation of primary obstructed megaureter in children

Abstract Objectives: To present a novel ureteric re-implantation technique for primary obstructed megaureter (POM) that ensures success in the short- and long-term, as conventional techniques are not ideal for megaureters especially in children, with ureteric stenosis and reflux being common complications after re-implantation. Patients and methods: Between 2009 and 2012, 22 paediatric patients with POM were enrolled. We performed a new technique for re-implantation of these ureters to ensure minimal incidence of ureteric strictures and easy subsequent endoscopic access. We performed follow-up voiding cystourethrography (VCUG) at 6 months postoperatively. Results: The cohort comprised 14 boys and eight girls, with a median age of 22 months. Six patients underwent bilateral re-implantation. The mean (range) duration of indwelling ureteric catheterisation was 7.8 (4–14) days. There were no complications in the perioperative and postoperative periods. There was no reflux on follow-up VCUG in any of the patients. One patient developed Grade I reflux after 1 year and presented with a urinary tract infection. Diagnostic cystoscopy was performed in 13 patients showing that the nipple was directed similarly to the native ureteric orifice. Conclusion: The embedded-nipple technique for re-implantation of POM guarantees successful results and permits easy subsequent ureteroscopic access when needed.