Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography.

INTRODUCTION: Our ability to diagnose renal cell carcinoma (RCC) has increased in the past 30 years as a result of the extensive application of imaging techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging. Multi-detector computed tomography (MDCT) remains the most appropriate imaging modality for the diagnosis and staging of RCC. The aim of this work was to compare the findings of MDCT with surgical pathology to determine the accuracy of delineating tumor size, localization, organ confinement, lymph node metastases, and the extent of tumor thrombus in the renal vein and inferior vena cava. METHODS: The clinical, surgical, and anatomo-pathologic records of 99 patients treated by nephrectomy (radical or partial) for solid renal tumors at Theodor Bilharz Research Institute and Nasser Institute from 2005 to 2011 were reviewed retrospectively. All cases were staged pre-operatively with abdominal MDCT (pre- and post-contrast enhancement) in addition to the routine biochemical, hematological, and radiological work-up. The tumors' histologic types were determined according to the WHO classification of renal tumors in adults in 2004, and staging was updated to the TNM 2010 system. Data were analyzed using the t-test. RESULTS: The mean age was 52 (range 21-73). Seventy-eight patients were males, and 21 patients were females (Male/Female ratio: 3.7:1). There were no significant differences in the mean tumor size between radiographic and pathologic assessments in different tumor stages. The overall incidence of lymph node invasion in surgical specimens was 76%, whereas MDCT showed a positive incidence in 68.4% of cases (false negative result in 7 cases, 7.6%). CONCLUSION: Our findings indicated that MDCT urography is an accurate method to estimate renal tumor size, lymph node, vascular and visceral metastases preoperatively. Also, preoperative staging of renal tumors with MDCT represents a valuable and accurate tool.

COMPARISON OF PAIN CONTROL DURING TRUS GUIDED BIOPSIES BETWEEN BASAL PERI-PROSTATIC LOCAL INFILTRATION ANESTHESIA VERSUS COMBINED TOPICAL ANAL LIGNOCAINE OINTMENT AND LOCAL INFILTRATION ANESTHESIA.

Control of pain associated with TRUS guided biopsies was the target of many researches that tried peri-prostatic local infiltration anesthesia (PLIA) either basal, apical, combined or topical anesthesia (TA). Thus, the efficacy of (PLIA) alone versus (PLIA) combined with (TA) in pain control during TRUS guided biopsies was compared. A total of 163 patients with a mean age±2stdev (61±1.4 years) and a mean PSA ± 2stdev (8.5±1. lng/ml) 84 patients (Gl) were randomized to receive either PLIA alone (Gl) or 79 patients (G2) combined TA (using lignocaine 5% ointment of the anal ring, anal canal, and anterior rectal wall and basal PLIA via injecting 5 ml 2% xylocaine in both sides of the base), with cross-matched mean ages. Patients were asked to scale pain from 0-10 during probe insertion (P1), periprostatic infiltration (P2) and after taking biopsies in all patients (P3) using the visual analogue pain scale to complete a visual analogue scale questionnaire. The patients in G2 showed significantly less pain scores at all stages of the procedure (P1, P2 & P3) in comparison tp patients in G1 especially regarding P1 and P2. The mean reported pain score was 24, 4±5, 6 and 15, 8±3.8 for G1 & G2 respectively, with significant difference (p=0,022).

Value of Computed Tomography for Predicting the Outcome After Percutaneous Nephrolithotomy.

INTRODUCTION: Computerized tomography of the urinary tract (CT-UT) has been established as the diagnostic procedure of choice for urinary stones. This study aimed to evaluate its role in predicting the outcome of percutaneous nephrolithotomy (PCNL) in terms of stone free rate and residual fragments. METHOD: This prospective cohort study was conducted on 34 patients in the Urology Department of Theodor Bilharz Research Institute from January 2013 to March 2014. The patients who had large and/or multiple renal stones, including staghorn stones, in 19 renal units scheduled for PCNL were included in this study. All had a pre-operative CT-UT to determine the stones' characteristics and renal anatomy. CT-UT, together with a kidney-Ureter-Bladder (KUB) film, was taken on the first post-operative day. The data were analyzed by SPSS version 17 using independent-samples t-test and the chi-squared test. RESULTS: CT-UT showed a statistical significant sensitivity in detecting residual fragments over standard KUB, yet this significance was lost when corrected to significant residual. Stone size and density were independent factors for the presence of residual stones. CONCLUSION: CT-UT post PCNL was sensitive to detect residual fragments, yet it showed no superiority over standard KUB in detecting significant residual.

Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer: short and long-term follow-up.

PURPOSE: We analyzed the impact of a single Mitomycin C instillation in patients with low risk superficial bladder cancer with short and long-term follow-up. PATIENTS AND METHODS: This study was conducted on 63 patients with low risk superficial bladder transitional cell carcinoma (TCC), admitted to the Urology Department, Theodor Bilharz Research Institute (TBRI) during the period from January 2002 to August 2005. All patients had a 2 cm. or less single, papillary, primary or recurrent tumor and were disease-free for more than 1 year. Patients with muscular invasion, G III tumor or bladder carcinoma in situ on pathological examination were excluded from the study. The tumor was completely resected before patients were divided randomly into 2 arms: first group who have received no further treatment (control group) and a second group with a single immediate instillation of 30 mg. Mitomycin C (mitomycin C group). Recurrences were considered early if they occurred within the first 2 years of follow-up. RESULTS: At 24-months follow-up, the recurrence-free interval was significantly increased and recurrence, recurrence per year and tumor per year rates were decreased in the mitomycin C group compared to the control group. Early recurrence was (16.1%) in the mitomycin C group versus (34.3%) in the control group. It was noted also that early recurrences were concentrated in the first year in the control group (18.7%) versus (3.2%) in the mitomycin C group. However, at long-term follow-up, these differences were not statistically significant (26.9%) in the mitomycin C group versus (28.6%) in the control group, and the recurrence-free interval curves were parallel. A significant relationship between early and late recurrences was found in the mitomycin C, but not in the control group. Shorter hospital stay and catheterization periods were noted in the mitomycin C group compared to the control group, but the differences were not statistically significant. CONCLUSION: These data confirm the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. This benefit is limited to early recurrence and is not maintained with long-term follow-up. Thus, this approach is an alternative to observation or classic long-term intravesical chemotherapy. Our study also suggests that cell implantation as a mechanism of early recurrence can be controlled or minimized with a single mitomycin C instillation.