Mohamed Abdel-Basir Sayed

Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management

Objective To determine the causes of steinstrasse, methods of prevention and treatment strategies.

Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi.

Objective. To evaluate the potential role of tamsulosin in the medical treatment of distal ureteral stones. Material and methods. Ninety patients with symptomatic distal ureteral calculi were enrolled. They were randomly divided into two groups: Group A (n=45) received diclofenac 100 mg on demand for 4 weeks plus levofloxacin 250 mg daily for the first week and were well hydrated; and Group B (n=45) received the same therapy plus tamsulosin 0.4 mg/daily for 4 weeks. Abdominal ultrasound scans and KUB X-rays were performed weekly. Stone expulsion rates, time to expulsion, pain episodes and analgesic usage were determined. Intervention by means of shock-wave lithotripsy (SWL) or ureteroscopy was evaluated. Results. The stone expulsion rate was 51.1% for Group A, compared to 88.9% for Group B (p=0.001). The average time to expulsion was 12.53±2.12 days for Group A and 7.32±0.78 days for Group B (p=0.04). The number of pain episodes was significantly lower in Group B and mean use of analgesics was lower for Group B (0.14±0.5 vials) than Group A (2.78±2.7 vials). Twenty-two patients in Group A failed to pass their stones after 4 weeks but only five in Group B. Of the patients who were not stone-free, 19 were treated with SWL and eight underwent ureteroscopy. Conclusion. Our study reveals the efficacy of tamsulosin for the treatment of distal ureteral stones. Tamsulosin should be added to the standard medical approach for treating these stones.

Expression of cell cycle-associated proteins in non-muscle-invasive bladder cancer: Correlation with intravesical recurrence following transurethral resection

The objective of this study was to evaluate the expression patterns of cell cycle-associated proteins in newly diagnosed non-muscle-invasive bladder cancer (NMIBC) to clarify the significance of these proteins as prognostic predictors in 161 consecutive patients undergoing transurethral resection (TUR). Expression levels of 7 cell cycle-associated proteins, including Aurora-A, c-erbB2, cyclin-D1, Ki-67, p21, p27, and p53, in TUR specimens were measured by immunohistochemical staining. Of the 7 proteins, weak expression of p21 was significantly associated with the incidence of intravesical recurrence (P = 0.012). Univariate analysis identified expression level of p21, tumor size, T stage, and concomitant carcinoma in situ (CIS) as significant predictors for intravesical recurrence (P = 0.0053, 0.0014, 0.024, and 0.035, respectively). Of these, p21 expression, tumor size, and concomitant CIS appeared to be independently related to intravesical recurrence (P = 0.029, 0.025, and 0.016, respectively). Furthermore, there were significant differences in intravesical recurrence-free survival according to positive patterns of these 3 independent factors; that is, intravesical recurrence occurred in 17 of 72 patients who were negative for risk factor (23.6%), 30 of 57 positive for a single risk factor (52.6%), and 24 of 32 positive for 2 or 3 risk factors (75.0%). These findings suggest that consideration of expression levels of cell cycle-associated proteins, in addition to conventional parameters, would contribute to accurate prediction of intravesical recurrence following TUR of NMIBC. Moreover, combined evaluation of p21 expression, tumor size, and concomitant CIS might be particularly useful for further refinement of the outcome in predicting intravesical recurrence following TUR of NMIBC.

Expression of integrin proteins in non-muscle-invasive bladder cancer: significance of intravesical recurrence after transurethral resection

Study Type – Aetiology (case control)
Level of Evidence 3b