ANURIA SECONDARY TO HOT WEATHER-INDUCED HYPERURICAEMIA: DIAGNOSIS AND MANAGEMENT

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

ANURIA SECONDARY TO HOT WEATHER-INDUCED HYPERURICAEMIA: DIAGNOSIS AND MANAGEMENT

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

Varicocelectomy: Modified loupe-assisted versus microscopic technique – A prospective comparative study

Abstract objective: To compare our novel loupe-assisted varicocelectomy (LV) technique to the ‘gold standard’ demanding microscopic varicocelectomy (MV) technique for the management of varicoceles. Patient and methods: Our LV technique, featuring testicular delivery and proximal spermatic cord occlusion using a tourniquet, has not been used before nor to our knowledge has it been reported in the literature. In the LV group, inguinal incision was done prior to testicular delivery and spermatic cord occlusion. Pampiniform and gubernacular veins were identified then tackled. Proximal spermatic cord occlusion helped in identifying those veins, and not confusing them with other cord structures that should be preserved. In all, 95 infertile men were included in this prospective, comparative study; and divided into LV and MV groups. They were followed-up for 1 year, pregnancy achievement, improvements in semen parameters, and complication rates were assessed. Results: Both groups had statistically significant pregnancy rates and negligible complication rates. However, LV cost 33% less than MV and was quicker to perform. We did not find that the MV technique was better than our simple, more cost-effective, less time-consuming LV technique. Conclusion: Our novel LV technique has similar success and complication rates as the ‘gold standard’ MV technique for the management of varicoceles, and is more cost-effective and less time consuming

Relative contribution of digital rectal examination and transrectal ultrasonography in interpreting serum prostate-specific antigen values for screening prostate cancer in Arab men

Background: This study was conducted to determine the utility of digital rectal examination (DRE), transrec-tal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia, an area of the world with a relatively low incidence of this disease. Patients and Methods: 329 patients suspected of having prostate cancer on account of raised serum PSA level (> 4 ng/ml), DRE or TRUS findings, underwent TRUS-guided prostate biopsy. Raised PSA individually as well as combined, or a lesion suspicious of carcinoma on DRE or TRUS was recorded as PSA (+), DRE (+) or TRUS (+), respectively. The contribution of DRE, TRUS and serum PSA to the diagnosis of prostate cancer was analysed. Results: Of the 329 patients who had prostate biopsies 109 cases (33.1%) had PCa. Of these 109 patients 56 (51 %) had DRE (+), 77 (42%) had TRUS (+) and 49 ( 66%) had both DRE (+) and TRUS (+). Statistical analysis revealed that DRE (+) tripled the probability for cancer. PSA over a range of 10-50 ng/mL demonstrated an in-creasing cancer probability ranging from 2 to 3 fold. TRUS (+) was only significantly associated with cancer risk if PSA was elevated. The presence of all three factors increased the cancer probability by 6 to 7 fold. Conclusion: TRUS findings are dependent on PSA for interpretation while DRE (+) with elevated PSA makes PCa more likely

Antioxidant Therapy Is Associated with a Reduction in the Serum Levels of Mediators of Renal Injury

Objective: To investigate the effects of antioxidant therapy on the levels of mediators of shock wave induced renal injury in patients with renal calculi treated with extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: One hundred and twenty patients with renal calculi were divided into three treatment groups: Group A patients (n = 39) served as a control group; Group B patients (n = 41) were given 2 capsules of Nature Made® antioxidants 2 hours before, and 2 and 8 hours after ESWL and Group C patients (n = 40) were given 2 capsules of the antioxidants at 2 and 8 hours after ESWL. Blood and urine samples were obtained from all patients just before the start of treatment with ESWL, and at 2 and 24 hours and on day 7 and 28 after ESWL. Levels of mediators of renal injury such as serum alkaline phosphatase (ALP), C-reactive protein (CRP) and lactate dehydrogenase (LDH) were measured. Urinary levels of albumin and ALP were also determined as measures of renal tubular injury. Results: Patients given antioxidants had significantly reduced mean serum concentration of ALP (p < 0.001) at 24 hours, lower serum ALP and LDH on day 7 and 28, and lowest CRP on day 28 after ESWL. They also had higher urine albumin (p < 0.001) and ALP (p < 0.001) levels (from 24 hours to day 28) compared with patients who were not given antioxidants. Conclusion: These findings suggest that oral antioxidant therapy prior to lithotripsy may reduce the severity of long term renal injury caused by the shock waves

Comparative Analysis and Interobserver Variation of Unenhanced Computed Tomography and Intravenous Urography in the Diagnosis of Acute Flank Pain

Objectives: The purpose of this study was to compare unenhanced computed tomography (UECT) to intravenous urography (IVU) for detecting urinary tract calculi, signs of obstruction and non-renal causes in the assessment of acute flank pain, and in their interobserver agreement. Patients and Methods: In this prospective study, carried out at a university hospital over a period of 1 year, 36 patients (27 males and 9 females) participated. Mean age was 44 8 15 years (range: 14-73 years). The patients presented with acute flank pain and underwent UECT and IVU. The images were blindly evaluated by 2 experienced radiologists and the two techniques compared using the two-tailed McNemar's test for matched pairs; p values <0.05 were considered significant. Results: UECT detected stones in 11 (30.6%) patients, while IVU found them in only 8 (22.2%). The increased detection by UECT was due to its ability to detect smaller stones (<6 mm). UECT was also found to be better than IVU in determining calculus position, in detecting primary or secondary signs of obstruction and in identifying non-urinary causes of flank pain. The overall average of agreement, as indicated by kappa values, was 0.88 for UECT and 0.61 for IVU. Conclusion: UECT showed better detectability and interobserver agreement tan IVU, suggesting that UECT could replace IVU as the first imaging modality in the evaluation of acute renal colic. Copyright (C) 2010 S. Karger AG, Base

Treatment of renal calculi by lithotripsy: minimising short-term shock wave induced renal damage by using antioxidants

Treatment with extracorporeal shock wave lithotripsy (ESWL), the preferred method of treating kidney stones <3 cm in size, has been shown to induce silent and often self-limiting acute and chronic lesions in the kidneys and adjacent organs. We conducted a randomized clinical trial to determine whether ESWL produces ischaemia and reperfusion injury in the kidneys and whether oral administration of antioxidants reduces the degree of short-term renal injury in patients treated with ESWL. The study included 120 patients with renal stones (1–3 cm in size) treated with ESWL. The patients were divided into three groups—patients in group A (n = 39) served as a control group and were not given any antioxidants; patients in group B (n = 41) were given two capsules of antioxidants “Nature Made r” 2 h before ESWL, and 2 and 8 h after ESWL; and patients in group C (n = 40) were given two capsules of the antioxidants 2 and 8 h after ESWL. Double ‘J’ stents were inserted in patients before treatment with ESWL. Blood and urine samples were obtained from all patients just before the start of treatment with ESWL, and at 2 and 24 h and on 7th and 28th day after ESWL. Serum levels of malondialdehyde (MDA), α-tocopherol, cholesterol, albumin and ascorbic acid, and α-tocopherol/cholesterol ratio were determined. Urinary levels of albumin and β2 microglobulin were also determined as measures of renal tubular injury. At 24 h after ESWL, patients given antioxidants (groups B + C) had significantly reduced mean serum concentration of MDA (P < 0.001); higher levels of serum ascorbic acid (P < 0.001) and serum albumin (P < 0.001); lower α-tocopherol/cholesterol ratio, lower urinary albumin and β2 microglobulin levels compared with patients who did not receive antioxidants (group A). These findings suggest that treatment with ESWL generates free radicals through ischaemic/reperfusion injury mechanism, and that oral administration of antioxidant may protect these patients from short term renal injury caused by ESWL