Performance of urinary survivin as a non-invasive molecular marker of bladder carcinoma in a schistosomiasis endemic area

Objective: To compare the sensitivity, specificity, positive predictive value, negative predictive value of urinary survivin and that of urine cytology in the diagnosis of bladder carcinoma in a schistosoma endemic area.Design and setting: This is a 12-month prospective study of patients with features of bladder carcinoma as study group and patients with other urologic conditions and healthy volunteers as control group.Participants: Patients with features of bladder carcinoma formed the study group, while patients with other urological conditions and healthy volunteers formed the control group.Results: There were 52 patients in study group and 36 patients in control group. The mean ages of patients in the study and control groups were 47.17 ± 17.00 and 44.19 ± 18.89 years respectively. There were 48 males and 4 females in the study group, giving a male: female ratio of 12:1. Thirty-one (60 %) of the patients were farmers and 44 patients (85%) had history suggestive of schistosomiasis at childhood. The sensitivity of urine cytology and survivin in the study were 29.1% and 100.0% respectively. The specificity of urine cytology and survivin were 100.0%and 100.0% respectively (p= 0.05). The marker was associated with false positive (FP) results in patients with prostate cancer.Conclusion: Urinary survivin is highly sensitive, specific and predictive of bladder carcinoma in our environment. The marker is associated with false positive results in patients with prostate cancer.Funding: By authorsKeywords: survivin, urinary bladder carcinoma, schistosomiasis, sensitivity, specificit

Management of obstructive nephropathy in a tertiary hospital in North West Nigeria: A five-year review

Background: Obstructive nephropathy is managed initially with urinary diversion and possibly haemodialysis before definitive therapy. This study was aimed at determining the pattern of presentation, aetiology and management options of obstructive nephropathy in our practice.Methods: This was a five-year retrospective study of the patients managed for obstructive nephropathy at our facility from January 2011-December 2015. Data were collected via a pro forma and analysed using SPSS version 20.0.Results: There were 106 patients managed for obstructive nephropathy with a mean age of 48.3 ± 17. 4 years and age range of 4 months to 85 years. The male: female ratio was 10:1. The most common causes of obstructive nephropathy were bladder cancer (49.1%), benign prostatic hyperplasia (BPH, 22.6%), bilateral ureteric stone (5.7%) and bilateral schistosomal lower ureteric obstruction (4.7%). Urethral or suprapubic catheterisation (22.6%), nephrostomy (2.8%) and dialysis (10.4%) were the initial treatments. Chemoradiation was done for the patients with bladder cancer and 17.9% of the patients had operative interventions, which included ureteroneocystostomy, open prostatectomy or transurethral resection of the prostate, and ureteroscopy + lithotripsy. Fifty-two patients (49.1%) died while awaiting dialysis and four patients (3.8%) developed end-stage renal disease.Conclusions: Bladder carcinomas, BPH, ureteric obstruction are the commonest causes of obstructive nephropathy in our practice. The initial treatment includes urinary diversion and or dialysis before definitive treatment.Keywords: obstructive nephropathy; bladder cancer; acute kidney injury; chronic kidney injury; urinary diversion; dialysi