Yousef Ali

Leiomyosarcoma complicating chronic inflammation of the testis

Objective: To report on a case of leiomyosarcoma of the testis that appeared to have arisen from a background of chronic testicular inflammation. Clinical Presentation: A 65-year-old man with a 15-year history of diabetes mellitus and low-grade discomfort and swelling in the right testis presented as an emergency with exacerbation of the pain and swelling of the testis. Repeated ultrasound examination of the testis in the past 5 years had suggested a chronic testicular inflammatory disorder. Ultrasound during the current emergency case admission revealed a normal left testis, but a large heterogeneous solid mass with a moderate intratesticular calcification in the right testis and the presence of a moderate hydrocele. Serum α-fetoprotein and β-human chorionic gonadotropin were normal. A right radical orchidectomy was performed. Histopathology and immunohistochemistry revealed primary leiomyosarcoma of the right testis. There was no spermatic cord or venous involvement. One year after orchidectomy there was no sign of metastasis. Conclusion: Radical orchidectomy followed by surveillance appears to be the treatment of choice for this testicular leiomyosarcoma, which seemed to have run an indolent course compared to other testicular tumours.

Prostate cancer metastatic to the omentum

A 76-year-old man presented with palpable omental metastasis and gross ascites due to prostate cancer. Within 3 months of surgical castration, the ascites resolved completely, the omental mass was reduced by more than 75%, and serum PSA fell to 4.24 ng/ml from 368.4 ng/ml. Worthwhile palliation can be achieved in patients with massive effusions secondary to metastatic prostate cancer using hormone manipulation.

Women's Political Rights: Islam, Status and Networks in Kuwait

During the last decade, there have been signs of increased democratization in the Middle East. Yet womens political rights remain limited. In this article we focus on Kuwait, a country representative of how citizenship rights have been gendered in the Middle East. Some Kuwaiti womens groups support expanding womens political rights. This article seeks to determine if they have potential allies in the general population. Using survey data from 1500 Kuwaiti citizens in 1994, we identify potential advocates for extending womens rights by examining social status, social networks, religious identity and Gulf War experiences. We found that organized womens groups have potential allies in Sunni young people and men who belong to voluntary organizations, and Shia young men, older women and those who backed Islamic movements abroad. These groups form a basis for developing a broad base of popular support for expanding the citizenship rights of women.

Anuria secondary to hot weather-induced hyperuricaemia: diagnosis and management.

BACKGROUND There is little information on the management of anuria secondary to severe volume depletion or as a rare manifestation of heat stroke in areas of the world with very hot summers. We present our experience with hot weather-induced hyperuricaemia in Kuwait. PATIENTS AND METHODS Patients presenting to our urology unit as an emergency during the hot summer months of April to October (average temperature 40-55 oC) were suspected of having hot weather-induced anuria secondary to hyperuricemia if they had a history of working in the sun for 6 to 8 hours per day and a progressive decrease in urine output to complete anuria. The diagnosis was confirmed by demonstration of elevated serum creatinine and uric acid, ultrasound findings of normal kidneys, ureters, and bladder (KUB) or mild to moderate hydronephrosis, but no features of chronic renal disease and little or no urine in the bladder. Management consisted of emergency cystoscopy, retrograde pyelogram, ureterorenoscopy (URS), and J stents followed by rehydration, oral allopurinol and urinary alkalinization. RESULTS Twenty-nine patients (27 males and 2 females, mean age, 44.52A +/- 8.3 years) satisfied the diagnostic criteria for anuria secondary to hot weather-induced hyperuricaemia. Twentyeight (97%) patients worked outdoors on construction sites. Six patients had small radiopaque calculi on plain KUB X-ray. During cytoscopy and URS, uric acid crystals were encountered in all patients in the ureters and bladder. Recovery of renal function was complete in 23/29 (79.3%) patients, while 4/29 (13.8%) had partial recovery and 2/29 (6.9%) had no renal recovery. CONCLUSION Hot weather-induced anuria secondary to hyperuricaemia is a complication of severe dehydration. Effective treatment will result in successful resolution of this rare but reversible cause of acute renal failure in about 80% of cases. Ancillary treatment methods like haemodialysis or the use of PCN can be safely avoided in the majority of the patients. However, rehydration alone may be insufficient treatment in these patients.

Testicular Torsion: A Perspective from the Middle East

Objective: To report our experience in the management of testicular torsion with emphasis on seasonal variation, salvage rate and the status of the torted testis 3–6 months after orchidopexy. Subjects and Methods: Seventy-five patients with a presumptive diagnosis of testicular torsion, who presented to our hospital between January 1999 and December 2002, were included in the study. Following scrotal exploration, 63 patients were found to have testicular torsion. Of these, 11 with nonviable testes had orchiectomy while 52 with viable testes had orchidopexy. Both groups of patients had simultaneous contralateral orchidopexy. Patients who had orchidopexy were followed up 3-monthly by testicular ultrasound to assess the volume of the affected testis. Results: Sixty-three patients were confirmed to have testicular torsion. The average number of new cases in the winter was 6.7 compared to 4 in the summer. Fifty-two patients underwent orchidopexy to give an operative salvage rate of 82.5%. Of 51 patients in whom the duration of torsion was less than 24 h, 1 (2.0%) had a nonviable testis, whereas of 12 patients in whom the duration of torsion was more than 24 h, 10 (83.3%) had a nonviable testis. After a minimum follow-up of 3 months for patients who had orchidopexy, 7 (13.5%) developed testicular atrophy. The incidence rate was estimated to be 7.9 cases per 100,000 population. Conclusion: The highest incidence was during the cold season. The outcome of surgical management of testicular torsion was dependent on the duration of torsion.

Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis

Objective: To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen (PSA) in patients investigated for prostatic disease in Kuwait. Materials and Methods: Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. Results: Of the 331 tissue specimens, 18 (5.4%) did not show prostatitis, while 233 (70.4%) with benign prostate and 80 (24.2%) with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 (41%) with benign prostate disease and prostatitis and of the 72, 52 (76%) with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. Conclusion: The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer.

Bladder outlet and rectal obstruction secondary to a large pelvic hydatic cyst

Hydatid disease is a parasitic infection caused by the tapeworm Echinococcus granulosus. It is intensively endemic to the southern parts of South America, Australia, New Zealand, and parts of Africa and the Middle East.1,2 The prevalence rate has risen in other countries due to migrants from these endemic countries.2,3 Generally herbivorous animals and human beings become infected accidentally by swallowing the tapeworm eggs passed with dog faeces.2 Hydatid disease is characterized by cyst formation in any organ, although the liver is the most commonly involved organ, followed by the lungs. Rarely it can involve genitourinary organs such as the kidneys, bladder, seminal vesicles, and ovaries in females. The disease manifestation differs from one person to another depending on the organs involved, the size of the cyst, and the duration of infection. It varies from anaphylactic shock, infection, and sepsis to secondary manifestation due to the compression of adjacent organs by a very large cyst. We present a case of a 22-year-old Ethiopian housemaid who presented with a large abdominal mass that caused acute urinary retention and near absolute constipation.