Prostate cancer among Saudis: a registry review.

Background: Policy makers in Saudi Arabia greatly rely on published studies to make major public health decisions. Prostate cancer (PCa) studies in Saudi Arabia are either outdated or limited to local regions. Aim: The authors aim to analyze the Saudi Cancer Registry to determine the incidence of PCa across all regions of the Kingdom and the risk factors of poor prognosis in the population. Methods: Patients diagnosed with primary PCa from 1 January 2008 to 31 December 2017 were included in the study from the Saudi Cancer Registry. Incidence rates and risk factors for poor survival were calculated. Results: A total of 3607 PCa patients were retrieved. PCa incidence rates ranged from 0.2 to 1.4 per 100 000. Most of the patients were aged 60 and older (86.5%; n=3120), married (97%; n=3497) and lived in the central region (38.1%; n=1375). The mean age at diagnosis was 71.1 (10.8) years. Over half of all tumors were poorly differentiated (64.2%; n=2317), and localized (60.4%; n=2180). The all-time metastasis rate reached 31.4% (n=1131). The lowest mean survival was in those with distant metastasis (P=0.039). Age groups, marital status, tumor morphology, place of residency, and grade were not proven to significantly influence survival. Conclusion: The high metastasis rate and evidence of a greater incidence of newly diagnosed metastatic PCa indicate that the idea of select screening for certain high-risk populations is not farfetched. The authors encourage the promotion of awareness regarding PCa risk factors and screening to optimize prognosis and minimize late presentations and high metastasis rates.

Giant staghorn stone causing inferior vena cava compression: a novel case report.

Staghorn calculi (SC) are defined as large kidney stones that fill the renal pelvis and at least one renal calyx. They represent 10-20% of all renal stones in developing countries and require prompt diagnosis and management. Massive SC (over 5 cm) are treated exclusively via open surgery, despite percutaneous nephrolithotomy (PCNL) being the gold standard treatment for large stones. Descriptions of PCNL for massive SC are very limited in the literature. Case Presentation: We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5 cm and 1.8×4.5 cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained. Discussion: We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL - a procedure that has not been described for stones of such size. Conclusion: This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5 cm.

A retrospective cohort study on the use of machine learning to predict stone-free status following percutaneous nephrolithotomy: An experience from Saudi Arabia.

Background: Machine learning techniques have been used extensively in the field of clinical medicine, especially when used for the construction of prediction models. The aim of the study was to use machine learning to predict the stone-free status after percutaneous nephrolithotomy (PCNL). Materials and methods: This is a retrospective cohort study of 137 patients. Data from adult patients who underwent PCNL at our institute were used for the purpose of this study. Three supervised machine learning algorithms were employed: Logistic Regression, XGBoost Regressor, and Random Forests. A set of variables comprising independent attributes including age, gender, body mass index (BMI), chronic kidney disease (CKD), hypertension (HTN), diabetes mellitus, gout, renal and stone factors (previous surgery, stone location, size, and staghorn status), and pre-operative surgical factors (infections, stent, hemoglobin, creatinine, and bacteriuria) were entered. Results: 137 patients were identified. The majority were males (65.4%; n = 89), aged 50 years and above (41.9%; n = 57). The stone-free status (SFS) rate was 86% (n = 118). An inverse relation was detected between SFS, and CKD and HTN. The accuracies were 71.4%, 74.5% and 75% using Logistic Regression, XGBoost, and Random Forest algorithms, respectively. Stone size, pre-operative hemoglobin, pre-operative creatinine, and stone type were the most important factors in predicting the SFS following PCNL. Conclusion: The Random Forest model showed the highest efficacy in predicting SFS. We developed an effective machine learning model to assist physicians and other healthcare professionals in selecting patients with renal stones who are most likely to have successful PCNL treatment based on their demographics and stone characteristics. Larger multicenter studies are needed to develop more powerful algorithms, such as deep learning and other AI subsets.

Classical Seminoma With Secondary Undescended Testis in an Elderly Patient: An Incidental Finding With a Penile Fracture.

Cryptorchidism is a common condition among children; however, it is rare in adults and is associated with an increased risk of malignancy. The development of secondary undescended testes is recognized as a complication following inguinal surgeries such as hernia repair and orchidopexy. Herein, we describe the case of a 64-year-old male with a known past surgical history of right indirect inguinal hernia repair complaining of penile swelling. The patient was diagnosed with a penile fracture, and a genital examination further revealed a right undescended testis. The patient underwent penile fracture repair and right orchiectomy. Histopathology examinations showed classic seminoma. These findings show that the position of each testis should always be documented before, during, and after inguinal hernia repair due to the increased risk of undescended testis. Histopathological confirmation is necessary for such patients so that malignancy can be identified in its early stages and cured subsequently.

Testicular cancer among Saudi adults: Hands on a nationwide Cancer Registry over 10 years.

Background/objective: Testicular cancer (TC) is one of the most curable solid malignancies affecting young adults. The objective of this study was to identify factors affecting survival of Saudi adults who were diagnosed with testicular cancer over 10 years. Methods: This was a retrospective study with data extracted from the Saudi Cancer Registry for Saudi Adults diagnosed with TC from 2008 to 2017. We collected demographic information, including age, marital status, region of residency, year of diagnosis, and the survival status. In addition, the tumor factors included the basis of diagnosis, the origin of the tumor, histopathological group and subtype, and tumor behavior, stage, and laterality were collected. Results: A total of 869 patients were included, with a median age of 30 (IQR: 25-38). The highest percentage of the cases was 37.5% (326) in the Central region, followed by the Western region 24.6% (214). The primary site of the tumor was the testis 96.9% (842), 3.1% (27) in the undescended testis. The histopathological examination revealed seminoma in 44.8% (389), 33.5% (291) mixed germ cell tumor, 8.4% (73) embryonal carcinoma, 6.1% (53) teratoma, 2.6% (23) yolk sac tumor, 1.6% (14) choriocarcinoma, 0.3% (3) Leydig cell tumor, and 2.6% (23) sarcomas. Kaplan-Meier analysis revealed significant association between survival and the age groups (p = 0.001), histopathology group (p 0.04), histopathology subtypes (p = 0.01), and the stage of the tumor (p < 0.001). Conclusions: A notable increase in the incidence of TC among Saudi adults was seen, with a mortality rate of 5.4% over a period of 10 years. Longer survival was associated with age groups, seminomatous germ cell tumor, and lower tumor stage.

Rare tumours of the bladder: A Saudi registry based descriptive study.

Objective: There is limited literature focusing on the characteristics and behaviours of bladder tumours outside of the common three morphologies, that is, urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma. The presented study provides a descriptive analysis of rare bladder tumours in KSA. Methods: This retrospective cohort study included all patients with a primary rare bladder tumour between 1 January 2008 and 31 December 2017. The data were acquired from the Saudi Tumour Registry. Frequencies and percentages were then generated for the categorical variables, while means and standard deviations were calculated for quantitative variables. Results: The study included 65 patients. The majority (n = 35, 53.8%) were aged 60 years and older. The patients were predominantly male (n = 53, 81.5%) and the majority lived in the Western region (n = 26, 40.?%). The most diagnosed tumour morphologies were small cell carcinoma in adults (n = 11, 16.9%) and embryonal rhabdomyosarcoma in children (n = 14, 21.5%), with the dominant diagnosis method being histology of primary tumour in 98.5% of the patients. Most tumours were localised (n = 30, 46.2%) and multifocal (n = 34, 52.3%). The overall mortality rate was 24.6%, with an overall diagnosis to death interval of 1.14 ± 0.75 years wherein small cell carcinoma was the shortest (0.84 ± 0.24) days. Conclusion: There remains a gap in the literature regarding uncommon urologic tumours. Shedding light on these factors will aid in further understanding the patterns of tumour behaviour in the region. This will facilitate enhanced risk-and response-based screening strategies and more favourable outcomes. Additionally, formulating a global registry for such patients is recommended.

Bladder Embryonal Rhabdomyosarcoma Among Children: A Descriptive Overview From Saudi Arabia.

Introduction Although rhabdomyosarcoma (RMS) is the most common type of soft-tissue sarcoma seen in the pediatric population, it is rarely located in the bladder. This study aims to provide a descriptive overview of bladder rhabdomyosarcoma among children in Saudi Arabia. Methods This retrospective cohort study included all children diagnosed with embryonal rhabdomyosarcoma from January 1, 2008, to December 31, 2017. Frequency and percentage were used to display the categorical variables and a mean and standard deviation for the continuous variables. Data were collected from the Saudi Cancer Registry (SCR). Results A total of 16 patients were detected. Most of the patients (43.8%) were toddlers (1-3 years) and males (87.5%). Most of the tumors were multifocal (100%), well-differentiated (43.75%), and localized (43.75%). The mortality rate was 12.5% with a diagnosis to death interval of 1.26 + 0.46 years. The incidence pattern of bladder rhabdomyosarcoma fluctuated across the years. The highest incidence of bladder rhabdomyosarcoma (0.17) per 1 million was observed in 2012 while the lowest incidence (0.03) per 1 million was observed in 2015. Conclusion We concluded that tumor presentation in early childhood is associated with a better prognosis. Moreover, males are predominantly affected by this tumor. Through our study, we tried to fill the knowledge gap regarding the descriptive statistics of bladder RMS in Saudi children. We believe that it would add significant value to the existing literature and help in better understanding the disease.

A 10-Year Tertiary Care Center Experience With Adrenalectomies for Adrenal Tumors.

Background Due to limited data, our understanding of the trends and outcomes of adrenalectomy in the Saudi surgical practice is limited and insufficient. The aim of this study was to review the clinical data regarding the diagnosis and management of patients with adrenal masses and to assess the effect of surgeon specialty on the outcomes. Materials and methods The study included all adult patients who underwent an adrenalectomy for tumors from 2011 to 2021. The patient characteristics, tumor profile, and preoperative, perioperative, and post-operative variables were collected. Frequency and percentage were generated for the categorical variables, and mean and standard deviation were generated for the quantitative variables. Results A total of 55 patients were identified. Most of the patients had a well-defined (58.2%, n = 32), benign (85.5%, n = 47) mass located in the cortex (58.2% n = 32). The majority of the sample were asymptomatic (52.7%, n = 29), and the most frequent diagnosis was adrenal adenoma (47.27%, n = 26). The most frequent indication for surgery was tumor functionality (69.1%, n = 38). Surgeries were mostly laparoscopic (69.1% n = 38) and performed by a urologist (52.7%). The conversion to open surgery was 13%, the intraoperative complication rate was 9.1%, the post-operative complication rate was 7.3%, and the 30-day readmission rate was 3.6%. Intraoperative complications, post-operative complications, and conversion to open surgery were more frequent among general surgeons, while 30-day readmissions were more frequent among urologists. However, a statistically accurate association could not be found due to the small population size. Conclusion Open surgery was replaced by laparoscopic adrenalectomy as the surgery of choice for different adrenal pathologies. The findings reported in this study are substantiated by current literature, adding to our comprehension of adrenal tumor presentation. There are, however, some inconsistencies regarding the influence of gender on tumor development and the association between surgeon specialty and outcome in the literature that merit research. However, evidence regarding the contribution of comorbidities, such as hypertension, diabetes, and hypothyroidism, is lacking.

Achromobacter xylosoxidans Subdiaphragmatic Collection as a Result of a Dropped Stone During Laparoscopic Cholecystectomy.

After a cholecystectomy, dropped stones can serve as a nidus for abscess formation. Intrabdominal abscesses tend to cause irritation and inflammation of the peritoneum and are thus rarely asymptomatic. This report discusses a 38-year-old female complaining of a recurrent right upper quadrant pain that led to multiple hospital admissions. Her surgical history was significant for cholecystectomy six years back complicated by a retroperitoneal abscess which was drained twice. A computed tomography (CT) scan was done, and she was diagnosed with a subdiaphragmatic collection as a result of a dropped stone.

A Primary Urothelial Carcinoma Presenting as a Mid-Bulbar Urethral Stricture in a 30-Year-Old Male.

The bulbar urethra is the most common site of anterior urethral strictures. In this case report, we present a 30-year-old male who was referred to us as a case of mid-bulbar urethral stricture. Urethroplasty was booked and a papillary lesion was found on routine diagnostic cystoscopy. An open biopsy was taken which showed invasive high-grade papillary urothelial carcinoma with squamous differentiation. This case is rare in terms of a young age of incidence, a lack of risk factors, an absence of suspicious symptoms, and a short duration of signs and symptoms. Urologists should consider workup for malignancy even in young patients who present with an idiopathic urethral stricture and a short duration of symptoms.

Clinical Application of a Two-Step Percutaneous Nephrolithotomy in a Patient With Severe Kyphoscoliosis and a Malrotated Kidney.

This case report describes a two-step percutaneous nephrolithotomy (PCNL) in a 22-year-old male who had severe kyphoscoliosis and a malrotated kidney. The operation was performed with the patient under general anesthesia and in the left lateral decubitus position. All stones were successfully removed. No complications occurred during surgery, and the patient recovered well. Regardless of the posed challenges for kidney stone treatment in patients with spinal deformities, PCNL is not only a minimally invasive but also a safe and effective treatment option when done under correct positioning. The success rate is high, and the morbidity rate is low. According to the literature, only 125 cases of PCNL implications in kyphoscoliosis patients have been reported in emerging case reports and case series.

A Complication-Based Comparison Between the Posterior and Direct Lateral Approaches to Total Hip Arthroplasty: A Single-Center Experience.

Introduction Many approaches to performing total hip arthroplasty (THA) exist, primarily due to an insufficient amount of research that would favor one approach over the other. This study aimed to compare the risk of nerve injury, dislocation, Trendelenburg gait, and stem malposition between the direct lateral and posterior approaches to THA. Methods The study was a retrospective cohort study, and it was conducted in King Abdulaziz Medical City. It was directed toward adult patients who underwent THA from November 1, 2003, to November 1, 2018. All figures were obtained through the BESTCare system (ezCareTech, Saudi Arabia). Categorical variables were presented as frequencies and proportions. Quantitative variables were measured as mean and standard deviation. Fisher's exact test was used to compare the risk of complications between the two approaches. Results The posterior approach displayed a greater risk of stem malposition (p< 0.001) when compared with the direct lateral approach. However, neither approach showed a higher risk of dislocation, nerve injury, or Trendelenburg gait. Conclusions A higher risk of stem malposition was observed in the posterior approach, and there were no remarkable variances between the two approaches in the risk of dislocation, nerve injury, and Trendelenburg gait. Until more meticulous nationwide studies are available to provide evidence that would favor an approach over the other, the choice of surgical approach for THA remains to depend on the patient's characteristics and the surgeon's prior experience. Regardless of the approach, preoperative, intraoperative, and postoperative factors that increase the risk of complications should also be identified and addressed adequately.

Primary bone sarcomas in KSA: A Saudi tumor registry review.

OBJECTIVES: The geographical incidence of tumours is usually influenced by the environment, race, and culture. This study aimed to report the incidence and differences in tumour type, site of origin, and mortality across gender, regions, age, and the different characteristics of tumour types. METHODS: This retrospective cohort study included all patients diagnosed with primary bone sarcomas from January 1, 2013, to December 31, 2017. Frequencies and percentages were generated for categorical variables. Means and standard deviations were calculated for quantitative variables. A chi-squared test was used to detect differences among categorical variables. Student-t, ANOVA, and Tukey tests were used to detect differences among quantitative variables. Lastly, we calculated the incidence of each tumour type. RESULTS: Of 451 patients, 248 (55%) had osteosarcomas; 160 (35.5%) had Ewing's sarcoma, and 43 (9.5%) had chondrosarcoma. The incidence was 1.56 cases per 1,000,000 per year for osteosarcoma, 0.95 cases per 1,000,000 per year for Ewing's sarcoma, and 0.27 cases per million per year for chondrosarcoma. The three-year survival rate was 82.30%. Significant differences in tumour type, origin site, and three-year survival across age and gender were detected. Similarly, significant differences were also noted in origin site, grade, basis of diagnosis, and lateralisation across tumour types. CONCLUSIONS: In our study, the observed bone sarcoma incidence rates were lower than the ones reported worldwide. Understanding the pattern of tumour behaviour in the region will help develop a risk and response-based treatment plan for early decision-making.

Thirty-day readmission rates and associated risk factors after coronary artery bypass grafting.

OBJECTIVES: Coronary artery bypass grafting (CABG) is among the most frequently performed cardiac surgical procedures. However, it is associated with high readmission rates for a plethora of causes, which can substantially increase healthcare costs. This study aimed to assess the rates and associated risk factors of 30-day readmissions for CABG patients. METHODS: We conducted this retrospective cohort study at King Abdulaziz Medical City. The study targeted adult patients who underwent CABG between January 1, 2016, and January 31, 2019. Data were extracted from the BEST Care system. Frequencies and percentages were generated for categorical variables. Mean and standard deviation were calculated for quantitative variables. Bivariable and multivariable logistic regressions were used to detect readmission risk factors. RESULTS: Among 534 adult patients, the overall 30-day readmission rate was 16.1% (n = 86). The multivariable logistic regression analysis showed that diabetes mellitus (P = .002), amiodarone use (P = .04), statin use (P = .04), amlodipine use (P = .006), asthma (P < .001), and hyperlipidemia (P = .04) were significantly correlated with 30-day readmission. CONCLUSIONS: Our study showed an estimated 16.1% 30-day readmission rate after CABG. Diabetes mellitus, asthma, hyperlipidemia, and use of medications such as amiodarone, statins, and amlodipine were associated with readmission. Further studies are needed to develop tailored and practical strategies to reduce CABG readmissions and mitigate patient and health care facility burdens.