Mohamed Mohie Hashad

Safety of no bowel preparation before ileal urinary diversion

Study Type – Harm (case series)

Radiolucent Renal Stones in Children: Combined Use of Shock Wave Lithotripsy and Dissolution Therapy

OBJECTIVES To provide a noninvasive efficient modality for the treatment of radiolucent renal stones in children. Uric acid calculi comprise a significant proportion of urinary stones. METHODS This study included 24 children (10 girls and 14 boys) with radiolucent renal stones. Of the 24 patients, 5 presented with bilateral renal stones, 8 with multiple stones, 4 with staghorn stones, and 7 with a solitary renal stone. Their age range was 2-12 years (mean 6.3 +/- 2.8). The stone size range was 12-65 mm in the largest diameter. All patients were treated with combined extracorporeal shock wave lithotripsy (ESWL) and medical therapy in the form of urinary alkalization using potassium sodium hydrogen citrate and allopurinol for the treatment of hyperuricosuria. Before ESWL, 3 patients had a percutaneous nephrostomy tube inserted and 2 patients had a ureteral stent placed to relieve obstruction. ESWL was performed with a Siemens Lithostar using either general anesthesia or intravenous sedation. The follow-up period after stone clearance was 12-36 months (mean 26 +/- 7.2). RESULTS The stone-free rate of 100% was achieved in all 24 patients after 3 months of combined use of extracorporeal shock wave lithotripsy and dissolution therapy. CONCLUSIONS Combined ESWL and dissolution therapy accelerated stone clearance and delayed stone recurrence. The use of ESWL and medical therapy as a combined modality is a safe and effective treatment of radiolucent renal stones in children.

Mitochondrial DNA copy number variation as a potential predictor of renal cell carcinoma

Background Peripheral blood mitochondrial DNA (mtDNA) copy number alteration has been suggested as a risk factor for several types of cancer. The aim of the present study was to assess the role of peripheral blood mtDNA copy number variation as a noninvasive biomarker in the prediction and early detection of renal cell carcinoma (RCC) in a cohort of Egyptian patients. Methods Quantitative real-time polymerase chain reaction (qPCR) was used to measure peripheral blood mtDNA copy numbers in 57 patients with newly diagnosed, early-stage localized RCC and 60 age- and sex-matched healthy individuals as a control group. Results Median mtDNA copy number was significantly higher in RCC cases than in controls (166 vs. 91, p<0.001). Increased mtDNA copy number was associated with an 18-fold increased risk of RCC (95% confidence interval: 5.065-63.9). On receiver operating characteristic curve analysis, it was found that mtDNA could distinguish between RCC patients and healthy controls, with 86% sensitivity, 80% specificity, 80.3% positive predictive value and 85.7% negative predictive value at a cutoff value of 108.5. Conclusions Our results showed that increased peripheral blood mtDNA copy number was associated with increased risk of RCC. Therefore, RCC might be considered as part of a range of potential tumors in cases with elevated blood mtDNA copy number.

Bipolar vs monopolar resection of bladder tumours of >3 cm in patients maintained on low-dose aspirin: A randomised clinical trial

Abstract Objective: To compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm. Patients and methods: A prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT). The primary endpoint of the study was the decrease in postoperative haemoglobin (Hb) concentration measured using an automated cell counter. The secondary endpoints of the study were intraoperative blood transfusion or the occurrence of urethral trauma during cystoscopy and the need for re-coagulation. Results: The postoperative reduction in Hb concentration, was significantly lower in the B-TURBT group [mean (SD) 0.55 (0.26) g/dL] compared with the M-TURBT group [mean (SD) 1.24 (0.61) g/dL] (P < 0.001). There was also a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit and the mean postoperative hospital stay. There was no significant difference between the groups for the occurrence of obturator jerk, bladder perforation, and the need for blood transfusion. Conclusion: B-TURBT in patients maintained on low-dose aspirin is better than M-TURBT for minimising postoperative drop in Hb concentration.

Sexual activity and the risk of prostate cancer: Review article

INTRODUCTION Sexual activity can affect prostate cancer pathogenesis in a variety of ways; including the proposed high androgen status, risk of sexually transmitted infections and the potential effect of retained carcinogens within the prostatic cells. METHODS PubMed review of all publications concerning sexual activity and the risk of prostate cancer was done by two researchers. RESULTS Few publications could be detected and data were classified as a prostate cancer risk in association with either heterosexual or homosexual activities. CONCLUSION Frequent ejaculation seems to be protective from the development of prostate cancer. Multiple sexual partners may be protective from prostate cancer, excluding the risk of sexually transmitted infections. Homosexual men are at a greater risk for the diagnosis of prostate cancer.

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.

Studying the effect of type 2 diabetes mellitus on prostate-related parameters: A prospective single institutional study

Background To examine the effects of type 2 diabetes mellitus (DM) on the variables associated with prostatic growth including serum prostate-specific antigen (PSA), serum testosterone, and prostate volume, and to correlate these variables with the duration of diabetes treatment. Methods Our study was conducted over 3 months recruiting 501 men aged ≥ 55 years; of whom 207 had type 2 DM. Exclusion criteria were active urinary tract infection, suspicious rectal examination, urologic cancer, end-organ damage, and recent urological manipulations. Serum PSA and serum testosterone were measured. Prostate volume was determined by abdominal ultrasonography using an ellipsoid formula. Results The mean patient age was 60.21 ± 5.95 years. The mean PSA, testosterone, and prostate volume for diabetic men were 2.3 ng/mL, 3 ng/mL, and 56 g, respectively. The corresponding values for nondiabetic men were 3.5 ng/mL, 4 ng/mL, and 51 g, respectively (P = 0.001, P = 0.001, P = 0.03, respectively). The mean PSA density was 0.049 ± 0.043 ng/mL/cm3 in diabetics versus 0.080 ± 0.056 ng/mL/cm3 in non-diabetics (P < 0.001). Conclusion Type 2 DM is significantly associated with lower serum PSA and testosterone, and larger prostate volume.

Renal cell carcinoma: Are we attacking a different tumor over the past 10 years?

OBJECTIVE There is a noticeable increase in the presentation of different types of urological malignancies at a younger age of presentation, in our institution. The objective of our study was to investigate cases presented with renal cell carcinoma, managed in the past 10 years for any possible epidemiological and cancer characteristics changes. METHODOLOGY Retrospective data collection for cases managed by our institution in the time period (2002-2012) was done. We included patients with complete data and pathologically proven renal cell carcinoma at final diagnosis. RESULTS Complete data could be retrieved for 334 patients. The mean age of cases was 43.5 years, with 279 (83%), 200 (60%) and 128 (38%) of patients younger than 60, 50 and 40 years respectively. Males and females involvement were 191 (57%) and 143 (43%) respectively. By histopathology, 200 (60%) of patients had clear cell (CC) RCC and 134 (40%) patients had non-clear cell type (papillary or chromophobe). The mean tumor size was 10.9 cm and partial nephrectomy was applied for 16% of all the cases, including 65% for cases with tumor size less than 4 cm. CONCLUSION There is a marked increase in the prevalence of renal cell carcinoma in the past 10 years, among younger age group, with higher rate for involvement of female gender. RCC is tending to present with large tumor size and more prevalence of non-clear cell histopathology. The use of partial nephrectomy is accepted for patients presented with renal mass and can safely challenge larger sized tumors.