Mohammed Shahait

Bladder perivascular epithelioid cell tumours.

Perivascular epithelioid cell tumours, better known as PECOMAs, are a very uncommon pathological finding. In English medical literature it has rarely been reported. In the genitourinary system, mostly urinary bladder, the incidence is as low as 10 cases described since 2003 until now. In this case report, we present a urinary bladder PECOMA with a detailed pathological description and a review of literature.

Laparoscopic treatment of giant renal cystic echinococcosis

Hydatid disease is a parasitic infestation caused by the larval form of the cestode Echinococcus granulosus. Isolated renal involvement is quite rare. Surgery is the mainstay of treatment and is classically performed through an open approach with kidney-sparing when feasible. The case of a 33-year-old male patient who underwent laparoscopic unroofing of a giant renal hydatid cyst is described herein.

Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.

Partial nephrectomy for metastatic renal cell carcinoma: Where do we stand?

Nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) offers comparable oncologic results, but a lower risk of chronic kidney disease, when compared with radical nephrectomy. However, there are limited data in the literature examining the safety of NSS in the setting of metastatic RCC. To evaluate the feasibility of NSS and impact on cancer-specific survival (CSS) in patients with metastatic disease, we performed a systematic review of the literature. There is ample evidence that NSS is feasible in metastatic RCC, with comparable results in terms of CSS compared with radical cytoreductive nephrectomy.

Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy.

Hydatid disease of the urinary tract is uncommon, accounting for only 2-3% of cases. There are very few reported cases in the literature of pelvic hydatid cysts causing obstructive uropathy and renal failure. We report a case of pelvic hydatid cyst in a patient presenting with urinary retention and secondary complete atrophy of one kidney. The patient was treated with surgical excision of this large retrovesical cyst, along with a simple left nephroureterectomy, with rapid improvement of symptoms. Hydatid disease should be taken into consideration in the differential diagnosis of a cystic mass in any anatomic localization, especially in patients from endemic areas.

Bladder Cancer Screening in Lebanese Population: There is Nothing more Unequal than the Equal Treatment of Unequal People

Bladder cancer screening has been perplexing the uro-oncological community for the last decade. In this commentary, we ruminate on the feasibility of bladder cancer screening in our population based on epidemiological proponents.

Ki-67 expression predicts biochemical recurrence after radical prostatectomy in the setting of positive surgical margins

BackgroundPositive surgical margin (PSM) is a predictor of biochemical recurrence (BCR) following radical prostatectomy (RP). Attempts to stratify PSM based on linear length, Gleason score, location and number have failed to add to predictive models using margin status alone. We evaluated the prognostic significance of Ki-67 expression in this setting.MethodsImmunohistochemical staining for Ki-67 was done on prostatectomy specimens from 117 patients who had a PSM. Ki67 expression was measured at the margin and in the index lesion. Patients were dichotomized based on Ki-67 expression into three groups. Group 1 with no Ki-67 expression, Group 2 with Ki-67 ≤ 2%, and Group 3 with Ki-67 ≥ 3%.To eliminate the impact of the adjuvant treatment (AT) on the outcome, data were analyzed by the Cox proportional hazards in which AT was Considered as a time-dependent covariate.ResultsThe discordance rate of Ki-67 expression between matched index lesion and margin specimens was 44/117 (37.6%). There was a trend for higher risk of BCR (HR:2.06, (0.97–4.43), P = 0.06) in patients expressing high Ki67 at the surgical margin although this was not statistically significant. However High Ki-67 expression in the index lesion was an independent predictive factor for BCR in this subset of patients. (HR:4, (1.64–9.80), P = 0.002).ConclusionHigh Ki67 expression in the index prostate cancer lesion is an independent predictor of BCR in patients with positive surgical margin following radical prostatectomy. Our findings need to be validated in a larger cohort.

Second primary malignancy after radical prostatectomy in a cohort from the Middle East

Background Data from the Middle East regarding second primary malignancy (SPM) after radical prostatectomy are limited. Our objective was to estimate the overall risk of developing second primary malignancy (SPM) among Middle Eastern men with prostate cancer who underwent surgical extirpation of their prostate. Materials and methods We conducted a retrospective study of 406 patients who underwent radical prostatectomy in a tertiary centre and who had no evidence of previous malignancy from 1998 to 2012. Standardized incidence ratios (SIRs) and 95% confidence interval (CI) were calculated to analyze the risk of SPM in our population compared with the general population. Cox-regression models were also conducted to correlate the clinicopathological factors with the development of SPM. Results After 14 years of follow-up, the incidence rate of SPM was 100.9 per 1,000 person-years. The most frequent SPMs were bladder cancer (n = 11, 27%) followed by hematological malignancies (n = 9, 22%) and lung cancer (n = 7, 17%). The overall risk for men with prostate cancer to develop SPM is lower than the men in the general population (standardized incidence ratios = 0.19; 95% CI: 0.14–0.25). A multivariate analysis failed to correlate any of the clinicopathological factors with the development of SPM. Conclusion Patients with prostate cancer who underwent surgical expiration of their prostate are at lower risk of developing SPM compared with the general population.

Contemporary Management of Urogenital Injuries

During the last decade, the conflicts in the Middle East have changed the face of the traditional war. This is evident from the following observations: the adoption of the whole enemy’s society as a battlefield, the indiscernibility between war and peace, the indistinction between military and civilian, and blitzing of the civilian facilities [53].