Bladder leiomyoma: report of two cases and literature review

Mesenchymal tumors of the urinary bladder are rare and the majority of them are malignant. We report two cases of leiomyoma of the urinary bladder presenting with symptoms of bladder outlet obstruction. The first patient was managed with staged transurethral resections, and the second with holmium laser transurethral inoculation. The outcome was excellent in both cases. A review of the literature is also outlined.     

Health related quality of life in ureteral stone patients: post-ureterolithiasis

Ureteral stones disease is among the most painful and prevalent among urologic disorders that can substantially impact health-related quality of life (HRQoL), particularly in patients with a history of recurrent stones. The aim of the study is to assess the QoL in patients with ureteral calculi after surgical intervention and identifying the most significant factors that could impact their QoL. The target population included two groups: post-lithotripsy patients and comparator group comprising healthy individuals selected from the general population. Both groups were matched for age and gender. The study continued through a period of 9 months. An observation period of 4–10 months following the last surgical intervention was applied before interviewing patients. Information regarding socio-demographics, medical data and presence of co-morbidities were recorded. The Medical Outcome Study Short-Form 36-item survey (SF-36) was used to assess HRQoL for both groups. Based on the SF-36 questionnaire, there were no significant differences between patients and healthy volunteers in the mean scores for eight of the HRQoL domains, except for pain and social functioning subscales. Patient’s age, distal ureteral stones and ureteral stent, in addition to DM and low back pain appeared to significantly affect the HRQoL of patients. In conclusion, the promising end point in the management of urolithiasis is improvement of HRQoL. The results of the current study support the notion that urinary stone disease is not a life threatening disease and patients can return to normal life after surgical intervention. Prospective studies are warranted for elucidating the factors influencing HRQoL in ureteral stone patients to optimize patient care.     

Varicoceles: the diagnostic dilemma

Clinical examination of the scrotum remains the most commonly used technique to diagnose varicoceles. However, scrotal anatomy (eg, thick scrotum, scarring, hydrocele) in some men may make physical examination alone unreliable. In these situations, imaging (eg, ultrasound, Doppler imaging, venography) may be used to diagnose a varicocele. The dilemma is that there are no widely accepted or used criteria to diagnose a varicocele based on imaging. This paper reviews the different imaging techniques used and the accuracy of each in diagnosing a varicocele.     

Is sputum cytology reliable for detection of atypical lung epithelial proliferative changes triggered by cigarette smoking?

Background: In recent years, Saudi Arabia has witnessed major tobacco smoking-related disease, such as cardiovascular disease and cancer, particularly among the younger population. Methodology: The present study aimed at evaluating the effect of cigarette smoke on lung epithelial cells. Results: This was a cross-sectional case-control study involving 300 apparently healthy volunteers living in Ha’il, Northern Saudi Arabia. Cigarette smokers (N = 100) were used as cases, and non-smokers (N = 200) were used as controls. A sputum specimen was obtained from each participant, employing all necessary safety precautions and sample adequacy measures. Results: Among 300 study subjects, cytologic atypia was identified in 14/300 (4.7%). Among the 14 cases with atypical cytologic changes, 13/14 (92.9%) were in smokers and 1/14 (7.1%) was in a non-smoker. The risk of lung cytologic atypia associated with cigarette smoking, was OR (95% CI) = 29.73 (3.82-230.87), P = 0.0001. Out of 300 study subjects, metaplasia was identified in 45/300 (15%). Among 45 cases with metaplastic changes, 26/45 (57.8%) were in the smokers and 19/45 (42.2%) were in non-smokers. The risk of lung epithelial metaplasia associated with cigarette smoking was OR (95% CI) = 3.34 (1.74-6.41), P = 0.0003. Conclusion: Cigarette smoking is a significant risk for developing lung epithelial atypia, lung metaplasia, and inflammatory cell infiltrate (especially chronic inflammation). Sputum cytology is a simple, non-invasive method that can be used in screening at-risk populations for early detection of lung proliferative changes associated with tobacco smoking.     

Septic shock after transrectal ultrasound guided prostate biopsy. Is ciprofloxacin prophylaxis always protecting?

We report a case of septic shock complicating transrectal ultrasound guided prostate biopsy despite antibiotic prophylaxis with ciprofloxacin. Patient was recently treated with the same agent for other infectious illnesses.     

Laparoscopic excision of para-aortic ectopic pheochromocytoma

Ectopic pheochromocytomas (paragangliomas) are rare tumors that are traditionally treated with open surgery. We present our technique of such a tumor treated laparoscopically and review the safety, feasibility and advantages of this approach.     

Pfannenstiel incision for intact specimen extraction in laparoscopic transperitoneal radical nephrectomy: a longitudinal prospective outcome study

OBJECTIVES:To evaluate the intra- and postoperative outcomes of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through a Pfannenstiel transverse suprapubic incision.METHODS:Prospective follow-up of 26 laparoscopic transperitoneal radical nephrectomies for suspected renal tumors in which the kidneys were extracted via a Pfannenstiel lower abdominal transverse incision.RESULTS:The mean operating time was 152.3 (80–255) minutes, and the mean blood loss was 90 (20–300) ml. The mean extraction time was 20.4 (12–35) minutes. The mean weight of the removed specimen was 631.5 (190–1505) grams, and the mean longest diameter of the extracted specimen was 17.4 (9–25) cm. The mean extraction incision size was 10.7 (7–16) cm. No open surgical conversions were necessary. Pain control was excellent, with minimal intravenous morphine equivalent narcotic use by patients: 15.7 (0–31) mg in the recovery room, 33.8 (0–127) mg on the first postoperative day and 8.7 (0–60) mg in the first week after discharge. The patients experienced a short duration to full ambulation and normal dietary intake. Postoperative follow-up visits were recorded for at least six months. The patients reported a high cosmetic satisfaction rate of 97.7% (60–100). No late postoperative complications were observed related to the extraction site.CONCLUSIONS:The operative specimen can be extracted via a low transverse Pfannenstiel incision during radical laparoscopic nephrectomy. This incision ensures the extraction of large specimens while preserving the aesthetic and functional advantages of laparoscopy without increasing the cancer risk. The absence of muscle cutting maintains the integrity of the abdominal wall and elicits minimal pain. No postoperative incisional hernias or keloid formations were observed.     

Sibutramine for the treatment of recurrent high-flow priapism

High-flow priapism most often occurs following perineal and penile trauma. We report the case of a 29-year-old man who presented with recurrent priapism and was initially treated with corporal aspiration and intracavernosal injections on multiple emergency department visits and then condition-controlled with sibutramine while on treatment for weight loss. His condition relapsed after the medication was withdrawn from the market, necessitating medical intervention.