Mohamed Abbar

Usefulness of adjunctive alpha1-adrenergic antagonists, after single extracorporeal shock wave lithotripsy session, in ureteral stone expulsion.

INTRODUCTION We evaluate the efficiency of α-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones. METHODS A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL. RESULTS In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stone-free. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%). CONCLUSION Adjunctive therapy with α1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of α-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.

Actitud expectante en el Síndrome del Cascanueces

Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. The nutcracker syndrome has been treated in various ways. We report one case of the syndrome and discuss the place of surveillance in its management.

Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml

OBJECTIVE To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml. MATERIAL AND METHODS Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml. RESULTS The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. CONCLUSIONS The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

Update the Indicator Role of Serum PSA Level and Gleason Score of the Biopsy for the Presence of Bony Metastases: Bone Scan Findings in a North African Ethnic Group

According to the American cancer society, prostate cancer (CaP) is the most common type of cancer found in American men, other than skin cancer. The estimated number of new cases of CaP in the United States in 2009 is about 192280; the assessed deaths will be 26730. It is known that there is a wide geographic variation in the incidence of clinical prostate cancer. In the african population, the incidence and mortality rates of CaP are strikingly higher than that in chinese or caucasians ethnies [1,2]. There is evidence that genetic, environmental and social factors jointly, often in combination, contribute to the observed differences in various populations. However due to the increasing awareness of the disease entity. The advent of the prostate specific antigen (PSA) testing for screening or early diagnosis and the improvement in life expectancy of the male population, the epidemiology of CaP in north-african ethnie has changed [3]. In our city, the incidence of CaP new cases is rapidly increasing, from 358 new cases registered in 1997 to 1068 cases in 2007, nearly tripling in 10 years. According to our national cancer register, a crude incidence rate is rising and the disease is being found earlier as well. However, the mortality from CaP is relatively static, with the number of deaths at 121 in 1997 and 289 in 2007, respectively. This implies that an increasing number of our citizens are living with cancer of prostate [3].

The usefulness of stone density and patient stoutness in predicting extracorporeal shock wave efficiency: Results in a North African ethnic group.

INTRODUCTION We determine the role of stone density and skin-to-stone distance (SSD) by non-contrast computed tomography of the kidneys, ureters and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL). METHODS We evaluated 89 patients who received ESWL for renal and upper ureteric calculi measuring 5 to 20 mm, over a 12-month period. The mean stone density in Hounsfield units (HU) and mean SSD in mm was determined on pre-treatment CT-KUB at the CT workstation. ESWL was successful if post-treatment residual stone fragments were ≤3 mm. RESULTS ESWL success was observed in 68.5% of patients. Mean stone densities were 505 ± 153 and 803 ± 93 HU in the ESWL successful and failure groups, respectively (p < 0.001, students t-test). The mean SSD were 10.6 ± 2.0 and 11.2 ± 2.6 cm in ESWL successful and failure groups, respectively; this was not statistically significant. CONCLUSIONS This study shows that stone density can help to predict the outcome of ESWL. We propose that stone density <500 HU are highly likely to result in successful ESWL. Conversely, stone densities >800 HU are less likely to be successful.

RETRACTED ARTICLE: Endorectal MRI accuracy and its staging evaluation contribution in prostate cancer: a North African ethnic group

The article ‘‘Endorectal MRI accuracy and its staging evaluation contribution in prostate cancer: a North African ethnic group’’ has been retracted at the request of the editor because it contains significant verbiage plagiarizing another publication: ‘‘Endorectal MRI for prediction of tumor site, tumor size, and local extension of prostate cancer’’ (Nakashima et al (2004) Urology 64 (1):101–105).

Les rhabdomyosarcomes paratesticulaires. À propos de trois cas

Paratesticular rhabdomyosarcoma is a rare and highly agressive tumor. The authors discuss the diagnosis and therapeutic problems raised by this lesion and report three cases with a review of the literature.

Upper urinary tract lipoma: A case report

Upper urinary tract (UUT) benign tumours are rare. We present a case of UUT lipoma in a 41-year-old man with left flank pain. A computed tomographic urography scan revealed an irregular thickening of the left renal collecting system wall extending from the upper calices to the renal pelvis. The diagnosis of UUT was made and the patient underwent a nephroureterectomy with bladder cuff excision, as standard treatment. However, macroscopic and histological examination revealed a lipomatous tumour with no sign of malignancy. To our knowledge this is the first reported case of its kind of a UUT managed first with a minimally invasive approach.

Resultados a los tres años de la reparación de un cistocele transvaginal con malla de propileno usando una técnica sin tensión

RESUMEN Objetivos Evaluar la eficacia y la seguridad a largo plazo de la implantacion transvaginal de una protesis sintetica no absorbible (Gynemesh®) para el tratamiento del cistocele mediante una tecnica vaginal sin tension. Materiales y metodos Estudio prospectivo de pacientes sometidas a correccion de un cistocele entre abril de 2004 y julio de 2007. Se cortaba una malla de propileno al tamano adecuado para cubrir todo el cistocele, dejando dos lenguetas a cada lado. Las dos lenguetas de la malla se colocaban despues en los espacios paravaginales sin tension ni suturas. Se utilizo la malla en 31 pacientes. Todas ellas tenian un cistocele sintomatico de grado ≥ 2, segun la clasificacion del punto medio de Baden-Walker. Se les revisaba inicialmente al cabo de uno y tres meses, y despues cada 6 meses. Resultados La edad media de las pacientes era de 58 anos (limites: 47-70 anos). La paridad media era de 5,8 (limites: 1-11) y el peso medio de 75 kg (limites: 60-82 kg). Todas las mujeres eran posmenopausicas. La operacion se combino con histerectomia vaginal en dos pacientes, colporrafia posterior en dos, perineorrafia en una, fijacion sacroespinosa en dos y cinta transobturadora para incontinencia urinaria de esfuerzo en 7 mujeres. La duracion media de la cirugia del cistocele fue de 23 minutos. En el grupo de pacientes tratadas no hubo complicaciones importantes como traumatismo de vejiga, uretra, intestino o grandes vasos. No se registraron complicaciones en el postoperatorio inmediato (hasta los 7 dias). No se observo hematoma ni infeccion en la zona quirurgica. En una paciente se detecto erosion de la malla, que se trato mediante extirpacion de la parte erosionada de la misma. El seguimiento medio fue de 36,4 meses (de 18 a 52). Segun nuestra definicion de exito, basada en los resultados anatomico y funcional, la tasa de curacion global fue del 74,19% (asintomatica sin cistocele o con cistocele de grado 1). La tasa de pacientes con mejoria (asintomaticas con cistocele de grado 2) fue del 19,35% y la de fracasos globales (sintomaticas o con cistocele de grado 3 o 4) de solo el 6,4% (dos mujeres). Comentario y conclusiones La interposicion de una malla de polipropileno subvesical transversal, sin tension, por la via vaginal, parece ser un procedimiento excelente para el tratamiento quirurgico definitivo del prolapso de la pared vaginal anterior. Se trata de un procedimiento simple, poco invasivo, reproducible y eficiente con baja morbilidad y bien tolerado. Los resultados parecen mantenerse estables a los tres anos de seguimiento.

Three-years results of transvaginal cystocele repair with polypropylene mesh using a tension-free technique

OBJECTIVES To evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of cystocele using transvaginal free tension technique. MATERIALS AND METHODS Prospective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele >or= 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1 and 3 month and then every 6 months. RESULTS The mean age of the patients was 58 years (range: 47-70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh. Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women). DISCUSSION AND CONCLUSIONS The interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of anterior vaginal wall prolapse. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. The results seem to be stable after three years of follow up.