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. 2016 Apr;8(Suppl 2):S163–S179.

Urology Infection

PMCID: PMC4869446
Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Renal aspergillosis: Report of a case from Madras, India

Pankajalakshmi V. Venugopal, Taralaksmi V. Venugopal, E. S. Ramakrishna

Department of Urology, Institutes of Microbiology and Pathology, Madras Medical College, Chennai, Tamil Nadu, India

Aspergillus flavus causing renal aspergillosis in a 60-year-old diabetic male from Arokonam, Madras is reported. He was admitted for colicky pain with a history of passing white fleshy masses in the urine once in 15 to 20 days. Investigations revealed hydronephrosis of the right kidney. Direct examination of the mass showed it to be composed of branching septate hyphae. Culture yielded a pure growth of A. favus. Histologic examination of the sections of the mass showed necrotic inflammatory tissue with numerous branching septate hypae.

This is the first Indian case of renal aspergillosis where the specific diagnosis was based on histopathology and culture.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Perinephric abscess: A different approach

T. G. Rao, M. A. Jones

Department of Urology, Sandwell District General Hospital, Sandwell, UK, Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia

The primary management of a perinephric abscess is generally accepted to be drainage alone. Subsequent nephrectomy is regarded as a hazardous operation and the subcapsular approach is usually recommended.

9 patients aged 16-74 years have been reviewed. The aetiology of the abscess was as follows:-

  • Calculus Disease 4

  • PUJ Obstruction 2

  • Horseshoe Kidney/Diabetes 1

  • Duplex Kidney 1

  • Uretero-Colic Diversion 1

Three patients with functioning kidneys were treated by drainage alone with complete resolution of the abscess. The remaining 6 patients underwent nephrectomy at least 4 months after drainage. 3 patients had distant spread from the abscess requiring additional surgical procedures. 1 nephrectomy was performed by the subcapsular route, and the remaining patients underwent trans-abdominal nephrectomy in the manner of a radical nephrectomy. There were no significant complications.

It is suggested that a trans-abdominal nephrectomy following drainage of a perinephric abscess is the safest and easiest method of nephrectomy in these cases and enables intra-abdominal complications to be minimized.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Xanthogranulomatous pyelonephritis: Analysis of eleven saudi patients and of the literature

M. S. Abomelha, M. Kourah, K. Al Otaibi

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic, atypical form of pyelonephritis which can mimic renal cell carcinoma and other inflammatory renal parenchymal diseases. XGP is an aggressive infection mostly unilateral with the classical presentation of non functioning obstructed kidney with stone formation and solid mass lesion.

We present eleven patients with histologically proven XGP, who were treated by nephrectomy or drainage and biopsy. The results are discussed and compared with those from the literature.

Presented at the: 6th Saudi Urological Conference National Guard King Khalid Hospital – Jeddah 27-28 November 1991

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Chronic pyelonephritis with microadenomas

Farouk Ghany, Khalid A. Khan

Department of Urology, King Fahad Hospital, Madinah, Saudi Arabia

Renal micro-adenomas are usually asymptomatic. Patients who are at risk for adenomas are those with chronic pyelonephritis and ESRD on long term dialysis. Some pathologists believe that adenoma is a precursor of carcinoma and microscopically the lesions can be similar. While size of the lesion is sometimes used to speculate, only the presence of metastases can decide malignancy.

This paper aims to show that some of our cases of chronic pyelonephritis may be harboring renal micro-adenomas. As well, the pathologist has to use sub-serial sections of less than 2 mm diameter to diagnose adenomas.

Over a three year period we have discovered two such cases, one of whom had renal bilharziasis. The case histories, Madinah incidence, microscopic slides, and results will be presented.

We conclude that these lesions are significant since the prognosis in cancer is worse than chronic pyelonephritis. Since only the presence of metastases can determine malignancy, these patients at risk require follow up. It is suggested that bilharziasis might initiate adenoma formation. As well, the chronic inflammatory irritative process of pyelonephritis may initiate oncogenesis.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Bilateral emphysematous pyelonephritis: An unconventional management

Akhileshwar Jha, S. J. Ashraf, Yogesh Govil, Ravi Kumar, Michael Abiodun

Department of Urology, Medicine and Radiology, King Fahd Central Hospital, Gizan, Saudi Arabia

Emphysematous Pyelonephritis is rare and to our knowledge this is the first case to be reported from Saudi Arabia. The patient meets the diagnostic criteria acute symptoms, female, diabetic, past middle age with U.T.I. (E.coli), she had no obstruction of urinary tract, often a factor.

Early Nephrectomy is usually recommended for intra parenchymal gas owing to high reported mortality without that. Duet ot still rarer bilateral nature of disease, we treated with Active conservative management with Antibiotics, Diabetic control and P.C.N. Drainage with good result for both kidneys.

Ultrasonography is superior to plain x-ray in Diagnosis, but C.T. remains most reliable diagnostic method. To demonstrate extent of Intrarenal gas.

Diagnosis should be considered in ill, elderly diabetic with abdo-pain, UTI, Typical gas in X-ray, we recommend trial of active conservative management with PCN and consider Nephrectomy in rapidly deteriorating cases, the case will be presented.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Chlamydial infection in Riyadh, Saudi Arabia

Sami A. Bashi, Mohammed S. Nouh, Talha M. Alshawaf, Kamal Halim

Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia

Sera from patients attending STD Clinic, a gynaecological clinic in Riyadh and from males and females without overt genital diseases attending a primary care clinic were tested for the presence of anti-chlamydial antibodies using an immuno-fluorescence test. Antibodies to chlamydial trachomatis were found in 66 (46%) of 145 male patients and 72 (36%) of 200 females attending a STD clinic and gynaecological clinic respectively, and in two (2%) of 100 men and in none of 100 women attending a primary care clinic. These results suggest that the prevalence of chlamydial infection in Saudi Arabia among both men and women is high. Since serious complications can follow chlamydial genital infection, it is imperative to carry out further investigations in this field.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Risk factors in wound infection following urologic surgery: A prospective study

Adel A. K. Sayed, Saoud A. Taha, K. T. Danso, L. Wosornu

Department of Urology, King Fahd Hospital of the University,

Al Khobar, Saudi Arabia, Department of Surgery, Division of Urology, King Faisal University, Dammam, Saudi Arabia

A total of 134 consecutive open urologic operations were studied prospectively for the rate, aetiology, and risk factors in wound infection. The methodology included direct intra-operative swab taking as it permits more accurate wound classification. The case mix was representative of general urologic practice: it included 25 renal, 24 ureteric, 14 prostate, 32 scrotal, 20 urethral, and 4 bladder procedures.

Patients’ variables included the following (mean + SD): age 32.4 + 20.7 years, Quetelet index 27.4 + 8, duration of operation 98 + 34 munites, and the male:female ratio was 9.3:1. It was found that 21% of the intra-operative swabs were positive, 97% of the organisms being aerobic: 165 of the patients were nasal carries of 5 aureus. The overall wound infection rate was 9% and it prolonged postoperative hospital stay by six days average. Risk factors found (and their magnitude) were: age over 60 years (X 2.2), prolonged postoperative hospital stay (X 15), and wound contamination (X4.3 and X14.3 for Classes 3 and 4 respectively). Neither diabetes mellitus, obesity, nor surgeon's rank was contributory. It was concluded that the 9% rate of postoperative wound infection was acceptable. However, appropriate prophylactic antibiotics may reduce it further, and from our data, we would recommend an amino-glycoside (eg. Amikacin) and Ampicillin combined.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Malacoplakia of bladder: Urologist's enigma. A case presentation with discussion

Akhileshwar Jha, Anupam Bhargava

Department of Urology, King Fahd Central Hospital, Gizan, Saudi Arabia

A rare granuloma of the gut, retroperitoneum and urinary tract, ‘Malacoplakia’ was named by von Hansemann in 1903 (Greek, ‘Malakos’-soft, ‘Plakos’ - plaque) soft plaque.

The pathology was previously described by Michaelis and Gutman whose characteristic ‘bodies’ have been subsequently shown to consist of phagocytes containing fragmented bacilli.

The rarity of the condition precludes standard treatment recommendation, but diathermy resection and selective antimicrobial therapy appears logical and effective.

Consideration of the diagnosis is recommended on discovery of unusual bladder lesions.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Fournier gangrene of the scrotum following anorectal disorders

S. Kattan, A. Youssef, E. El Bialy, A. Meabed, A. Koko

Department of Urology, Riyadh Central Hospital, Riyadh, Saudi Arabia

Five cases of fournier gangrene of the scrotum following anorectal disorder were encountered in a period of 2 years. Perirectal abscess was the most commonly associated abnormality occurring in 60% of patients, however, simple reduction of prolapsed haemorrhoid can be responsible. A chronic debilitating condition was encountered in 60% of our patients and E.coli was predominant organism cultured in all the 100% of cases. The mortality rate was 20% but serious life threatening complications occurred in 80% of patients. Error in diagnosis and delay in initiating the surgical treatment is the main cause of the high mortality rate associated with the disease. We advocate thorough rectal examination including proctoscopy in all cases of fournier gangrene especially if no obvious source of infection is apparent.

Presented at the: 7th Saudi Urological Conference Riyadh Armed Forces Hospital 11-12 November 1992

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Five years study of nosocomial urinary tract infection in KFH

A. Fallata, H. El Deeb

Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia

Nosocomial urinary tract infection (NUTI) continues to be a major health problem all over the world accounting for 20-50% of all nosocomial infections. This results in prolonged hospital stay and increases mortality for infected patients.

In our study, we analysed data over the last five years (June 1988 - May 1993) admitted to KFH who developed urinary tract infection 48 hours or more after hospitalization. Some patients had been treated but on reculture another organism was isolated and were considered as new cases. During this period there was 1425 cases of nosocomial urinary tract infections. Most of our patients were 60 years old or more (55%). The organisms mostly isolated were pseudomonas and E.coli.

Cases were divided according to diagnosis on admission, period of hospital stay and presence or absence of urinary catheter. Although it was expected to have higher incidence NUTI among females, in our study they constituted only 12% of the cases.

The role of patient characteristics, age, pre-existing diseases as well as organism sensitivity and hospital environment in the pathogenesis of NUTI will be discussed and recommendations for prevention given.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Recurrent urinary tract infection in women

Anthony Schaeffer

Department of Urology, Northwestern University Medical School, Chicago, Illinois, USA

Bacterial adherence to mucosal surfaces is a critical initial step in the development of urinary tract infections. Specific bacterial adhesions and cell receptors are required for interaction. The process is complex, because bacteria can vary their expressions of adhesions and the receptivity of epithelial cells is in a state of flux. Understanding these interactions will allow the clinician to better assess susceptibility and manage patients with recurrent urinary infection.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

The role of infection in the aetiology of urethral stricture in Saudi Arabia: A 10-year survey

S. R. El Faqih, S. H. Hassan, I. Husain

Department of Urology, College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia

In Western reports, 51-85% of all cases of urethral stricture appear to be aetiologically related to iatrogenic causes, whilst only from 3.3% to 14.6% of cases are associated with previous infection. In a 10-year survey of all men treated for urethral stricture at the King Khalid University Hospital, 1983-93, we examine the regional etiological implications and how these influence established methods of management. Specific infections continue to weigh heavily in pathogenesis of urethral stricture in the region and, despite reports to the contrary, optical internal urethrotomy affords a high rate of success in primary management.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Urinary tract infection in pregnancy

Amal Shafik Balbaa

Department of Urology, Al Mana General Hospital, Dammam, Saudi Arabia

Introduction and Aim of Work: Most studies of U.T.I. in Saudi Arabia have focused on the overall prevalence without specific stress on U.T.I. during pregnancy. This study was done to determine the frequency of significant bacteriuria in healthy pregnant females as well as the antibiotic susceptibilities of cultures pathogens.

Patients and Methods: From January 1992 till July 1993 mid-stream urine cultures were done from 900 healthy pregnant women and standard methods for identification of isolates were done. Antibiotic sensitivity was done on significant isolates.

Results and Conclusions: Significant bacteriuria was found in 71 cases (7.9%). Out of these cases 46 (5.1%) were symptomatic and 25 (2.8%) were asymptomatic. The most common organisms isolated were E.coli (46.5% of isolates), Klebsiella (22.5%), Streptococcus group B (15.5%), Staphylococcus epidermidis (7%), Streptococcus fetalis (5.6%), and one case each of Providencia and Enterobacter species. Antimicrobial susceptibilities with Cefixime against E.coli, Klebsiella and Streptococcus group B which are the most common organisms isolated during pregnancy, followed by Cephalexin, Cefuroxime and Augmentin.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Urinary tract infections and reactive arthropathy in Saudi patients

Kamal El Ghoneimy1,2, Mohamed Kamel1,2

Departments 1Urology and 2Rheumatology, Dr. Fakhry Hospital, Al Khobar, Saudi Arabia

Uropathic bacteria and viruses can cause inflammatory joint disease. Why a certain number of patients develop an arthritic complications, a question is still under investigation.

In a prospective controlled study, we examine the renal functions in patients with morning heel pain and non-discogenic L.B.P. We carry out routine urine samples, urine culture for genitourinary chlamydial infection by urethral and cervical swabs, demonstration of chlamydia trachomatous in urine sample and search for serum 1 gG antibodies against chlamydia. X-ray of heels and sacroiliac joints were done.

The joint affection in chlamydia-induced arthritis was of peripheral character. The arthritis is not destructive but inflammatory usually asymmetrical in 69% of patients. The affection of large joints of knees and sacroiliacs were detected in 31% of patients. Ensthesitis or inflammatory enthesopathy (inflammation of the insertion of tendon, capsule, ligament or fascia to bone) is predominant in 40% of patients with positive urinary tract infection. The extra-articular features are urethritis in 36%, prostatitis in 9%, cervicitis/salpingitis in 6% and conjunctivitis in 7%.

Patients with chlamydia-induced arthritis responds well to additional therapy of antibiotic treatment for 4 weeks duration. Further details will be discussed.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Urinary infections resistance problems pathogens

R. A. Dobardzic, A. Y. Nasrallah

Department of Urology, Kuwait University, Farwaniya Hospital, Kuwait City, Kuwait

This study determined the resistance patterns of recent urinary infection pathogens. Antimicrobial susceptibility has been determined by the automated microdilution (MIC) technique of the Vitek System (Hazelwood, USA).

Resistance (R%) patterns of urinary resistance problem organisms vs. Pipracillin, Ampicillin, Cefotaxime, Ceftazidime, Aztreonam, Gentamicin, Amikacin, Tobramycin, Ciprofloxacin, Norfloxacin, and Nalidixic acid are presented in figure.

In relation to previous Kuwaiti studies, the highest increase of resistance frequency was documented for Enterobacter strains to aztreonam (1989 only 7% r) and ampicillin, Ps. aeruginosa to gentamicin, and Acinetobacter to broad spectrum penicillin, aminoglycosides norfloxacin is still extremely low, probably because of local restrictive antimicrobial policy bs fluorinate quinolones.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Gram-positive urinary pathogens and their antimicrobial susceptibility patterns

R. A. Dobardzic

Department of Urology, Kuwait University, Farwaniya Hospital, Kuwait City, Kuwait

Due to widespread use of broad spectrum of antimicrobial, gram positive organisms are gaining increased importance as nosocomial pathogens of the urinary and other tracts, especially Enterococcus spp. and coagulase-negative staphylococci. Among bacterial isolates of urine cultures of ICU patients of Farwaniya Hospital, prevalence of Staphylococcus spp. is very high, second only to Escherichia coli. For this reason it is very important to know the susceptibility patterns of gram-positive pathogens, especially since they often display multiresistance.

Among beta-lactamase-positive S. aureus 100% of strains are resistant to penicillin-G and ampicillin, 20 to methicillin and cephatholin, and 43% to tetracycline. Coagulase-negative S. epidermidis exhibits an even higher resistance frequency.

Only 28% of E. faecalis strain are susceptible to tetracycline, 40% to streptomycin, 88% to gentamicin, and 50% to vancomycin (other 50% are moderately sensitive). The prevalence of quinolones susceptibility is high: 73% for ciprofloxacin and 88% for norfloxacin.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Epidemiology of urinary tract infection and bacterial resistance

Mamun Ezzibdeh, A. Al Dayel, S. Eqail, I. Al Oraifi, C. Layaz

Department of Urology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Two thousand urine samples with positive urine culture sent to King Fahd Military Medical Complex, Bacteriology Laboratory between 1989-1992 were reviewed retrospectively. Urine culture greater than 10 CFU/mo was defined as positive. The susceptibility testing was done by means of the Kirby Bauer disk diffusion technique or by determining MICs. The commonest isolated pathogens were E.coli Klebsiella pneumoniae Strephylococcus, Pseudomonas aeroginusa and Enterococcus/gram negative rods.

The antimicrobial susceptibility of the urinary organisms vs. Ampicillin, Cephalosporin, Trimethropin-sulfamethoxazole, Noroxin and Aminoglycosides are analyzed and presented.

We found that the bacterial resistance to routinely used antimicrobial agents like Ampicillin and Trimethropin-sulfamethoxazole is common.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Antibiotic resistance infections

Abdulmalik Tayeb, Mohammed Elahi

Department of Urology, Al Hada Military Hospital and Rehabilitation Programme, Taif, Saudi Arabia

A total of 83 spinal cord injury patients were evaluated.

Urinary tract infection was the common type of infection and most common organisms which developed antibiotic resistance were Pseudomonas Aurigenosa and E.coli.

This presentation will talk about the main causes for emergence of antibiotic resistance infections. In our center, the UTI rate was about 30% two years ago and now it has been reduced to about 15% by following a certain policy for treating the patients with UTI and by following a certain education programme for nurses and patients.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

The ICU urinary isolates and their susceptibility patterns

T. Ansari, R. A. Dobardzic

Department of Urology, Kuwait University, Farwaniya Hospital, Kuwait City, Kuwait

Urinary tract infections (UTI) are the most common form of nosocomial infections. Indwelling urinary catheters play a critical role in their pathogenesis. Organisms may be inoculated directly from the perineum at the time of catheter insertion; subsequent contamination of the urinary tract can occur as a result of intraluminal contamination by breach of a closed drainage system or extraluminal spread of organism from the perineum. The primary reservoir of the UTI organisms in the gastrointestinal tract. Alterations in normal gut flora as a result of systemic illness and broad-spectrum antibiotics cause a shift in flora.

In the ICU of Farwaniya Hospital, in the first half of 1992, the most common urinary isolates after Escherichia coli (47%) were fungi (19%), staphylococci (16%) and Pseudomonas (9%). The urinary prevalence of fungi and staphylococci are at least twice higher than from any other hospital ward.

This study also established the susceptibility patterns of ICU urinary isolates and compared them to respective urinary patterns from other hospital wards.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Urinary schistosomiasis: Case presentation

M. A. Kourah

Department of Urology, Riyadh Military Hospital, Riyadh, Saudi Arabia

Only the final fixed pathological states which are irreversible are the concern of urologists as a surgical territory.

One of the most common complications is stricture of the ureter. Most of the cases which are done in this hospital (Riyadh Military Hospital) started in 1980 with the arrival of Dr. M.S. Abomelha. The majority of these cases which required ureteric reimplantations were straight forward with no complications except two patients, one had recurrent stricture in few months time and required reimplantation twice and the second patient had urinoma and recurrent stricture and required reimplantation and he did quite well after that. All these patients with ureteric stricture have been followed up regularly in the outpatients and assessed with an I.V.U. and isotope renogram.

However, most of the surgical procedure (ureteric-reimplantation) are gratifying but sometimes it can be challenging.

Presented at the: 1st Saudi Urological Meeting Riyadh Armed Forces Hospital 12 May 1983

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

The role of radio isotope renal imaging techniques in bilharzial uteritis

Adel M. R. Youssef, Kamal Zaki, Shawky El Abd, Ahmed Moabed, Saleh Mohalhel, Faiz Shibl, Bertrand Dore

Department of Urology, Riyadh Central Hospital, Riyadh, Kingdom of Saudi Arabia

Bilharzial uteritis is common in patients with genito-urinary bilharziasis, urodynamically significant strictures however are less than generally believed.

Radio isotopic imaging techniques have been advocated as valuable non-invasive techniques for the assessment of renal function and for the evaluation of obstructive uropathy.

Our recent experience in utilizing radio isotopes in the evaluation, choice of management and follow up of patient with bilharzial uteritis is reviewed, comparing results with previous cases.

Presented at the: 4th Saudi Urological Conference Riyadh Central Hospital 18 September 1986

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Evaluation of extravesical lateral ureteroneocystostomy using transverse flaps in lower end bilharzial ureteric strictures

Shyam Mohan Dixit

Department of Urology, Najran General Hospital, Najran, Saudi Arabia

The problems associated with standard antireflux procedures for ureteroneocystostomies in bilharzial ureters. The extravesical approaches has been used and evaluated. The 48 non-refluxing ureters with lower end strictures in 30 subjects were selected over two and a half years time with mean follow up of about one year.

The diagnosis was based mainly on antegrade pyeloureterography. Two main groups:First (8) with single diseased ureters while others with both side strictured ureters. Three of the first group reimplanted after excision of the diseased portion, by anterior extravesical approach while the rest with lateral extravesical technique with transverse flap. The second group i.e. 40 ureters in 20 subjects, each ureter were operated separately by anterior and later approaches. The thickness of transverse flap taken as three times the internal ureteric diameter as standard.

Patients were followed and evaluated for restenosis and refluxes by ante and retrograde studies. There were more incidence of restenosis and reflux in anterior approach than lateral variety. Also it was comparatively difficult to catheterize in anteriorly placed ureters.

Presented at the: 4th Saudi Urological Conference Riyadh Central Hospital 18 September 1986

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Schistosomiasis in the hail region

Mohamed Shafiqur Rahman, Z. Saber, M. Shazly, B. Morgan, F. B. Domres

Department of Surgery, King Khalid Hospital, Hail, Saudi Arabia

In the study of the 590 urological inpatient cases in the last two-year period in King Khalid Hospital, Hail, 19 of them only were diagnosed as Bilharziasis (3.2%). All the patients were foreigners from Egypt (14) and Yemen (5). They were chronic cases, 5 of them had obstructive uropathy due to Bilharzial ureteric strictures or secondary calculi, who underwent operative treatment.

Additionally with regard to the prospective study of appendicitis cases out of 75 cases, 2 proved histologically schistosomiasis, both of the patients were from Egypt.

Data reviewed from the bilharzia center in Hail showed that bilharziasis is endemic in some areas of Hail region, which is rich in water and active-agriculture is going on. But still we did not get any native patient with urinary tract complication by schistosomiasis in our hospital.

Presented at the: 4th Saudi Urological Conference Riyadh Central Hospital 18 September 1986

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Evaluation of surgical techniques for bilharzial obstructed ureter

Rifaat Awad

Department of Urology, Abha General Hospital, Abha, Saudi Arabia

Fifty patients with bilharzial obstructed ureter were studied clinically, laboratory and radiologically. Evaluation of various surgical techniques which included resection anastomosis, flaps and others 2-24 months after the operation by clinical, laboratory and radiological assessment.

Resection anastomosis gave good results in comparison to other procedures. Clinical success after surgical correction of the obstruction exceeded the radiological improvement in the degree of calicectasis.

A new technique ‘Burried bladder tube flap’ was used for surgical correction of stricture lower and ureter with good result.

Presented at the: 4th Saudi Urological Conference Riyadh Central Hospital 18 September 1986

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Bilharzial vesico-ureteric reflux and bladder neck stenosis: Fact or fiction?

Ahmed I. A. Ibrahim, K. P. Patil, M. I. El Tahir, S. D. Shetty, N. Anandan

Department of Urology, Abha College of Medicine, Abha, Saudi Arabia

47 patients with histologically confirmed chronic urinary bilharziasis underwent micturating cysto-urethrography (M.C.U.) to look for vesico-ureteric reflux (V.U.R.) and bladder neck stenosis (B.N.S.). 13/47 patients (27.7%) were found to have V.U.R. of different grades (8 unilateral and 5 bilateral). None had evidence of B.N.S.

Urinary tract infection (U.T.I.), loin pain, hydro-ureter and renal failure were compared in patients with and without V.U.R. 2/13 patients (23%) with V.U.R. and 8/34 patients (23.5%) without V.U.R. had U.T.I. Ipsilateral loin pain was present in 8/13 patients (61.5%) with V.U.R. but 22/34 patients (65%) without V.U.R. also presented with loin pain. On I.V. Urography 11/13 patients (85%) with V.U.R. had ipsilateral hydro-ureter yet 30/34 patients (88%) without V.U.R. also had hydro-ureter. 2/13 patients (15%) with V.U.R. presented with renal failure and 3/34 patients (9%) without V.U.R. presented with renal failure (p > 0.05).

We conclude that U.T.I., loin pain, hydro-ureter and renal deterioration associated with bilharzial V.U.R. are not significantly different from the clinical significance and need for bilharziasis is questionable.

Presented at the: 6th Saudi Urological Conference National Guard King Khalid Hospital – Jeddah 27-28 November 1991

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Balloon dilation of bilharzial ureteric stricture: An old method with new concepts

Ibrahim Harake

Department of Urology, King Khalid Hospital, Najran, Saudi Arabia

Stricture of the ureters is a major and common complication of genito-urinary infestation with S. Hematobium. Many surgical modalities are available to deal with this pathology. However, there is no optimal surgical treatment. Replacement of the ureter with an ileal loop is an extensive surgery with a high morbidity rate. Reimplantation of ureters in the bladder fails to prevent further damage to the kidneys due to vesico-ureteric reflux or recurrent stricture of the reimplanted segment.

Here is a practical and easy procedure which could be an alternative to classical surgery. Balloon dilatation of the ureters using a uretero-renoscope offers fairly accepted results if compared to surgery with less surgical hazards and better socio-economical condition from which millions of patients would be helped.

Presented at the: 6th Saudi Urological Conference National Guard King Khalid Hospital – Jeddah 27-28 November 1991

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Case presentation: Problem solving urinary tuberculosis and schistosomiasis

A. Jamal

Department of Urology, Riyadh Military Hospital, Riyadh, Saudi Arabia

A 52 years old Saudi farmer from the south was admitted to hospital because of dysuria, hourly frequency and terminal hematuria. Two years previously, cystourethroscopy at Khamis Muschait Hospital showed a severe post-urethral stricture and a bladder biopsy showed bilharziosis which was treated with hycanthrone injections. On examination, he was cachectic weighing only 48 kgms and normotensive. General examination was normal.

Investigations on admission showed a raised schistosoma titre and E.S.R. and recurrent sterile pyuria. Creatinine clearance 66 mls/min. His chest x-ray showed evidence of old tuberculosis. His I.V.U. showed a non-functioning autonephrectomised tuberculous calcified right kidney and a left hydronephrotic kidney with a dilated left ureter secondary to a stricture at the lower end of the left ureter. A bladder biopsy showed tuberculous cystitis. He was given Praziquantel 30 mg/kg body weight stat dose and started on a nine month course of triple anti-tuberculous chemotherapy.

The patient was followed up regularly in the outpatients and the function of his left kidney was monitored at four monthly intervals with isotope renography which showed gradual deterioration and obstruction. His creatinine clearance fell to 26 mls/min. As such, he was admitted after completion of his anti-tuberculous chemotherapy and a left cutaneous ureterostomy was performed. Reimplantation of a diseased left ureter into a diseased bladder was discarded because of high risk of failure. Similarly internal colonic diversion was not chosen because of risks of biochemical disturbances and reflux to a single kidney. Once the patient is better with improved renal function, then a caecocystoplasty may be considered. Three weeks following his left cutaneous ureterostomy his creatinine clearance rose to 42 mls/min and there was good drainage both in his I.V.U. and isotope renography.

Presented at the: 1st Saudi Urological Conference Riyadh Armed Forces Hospital 12 May 1983

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Effects of anti-tuberculosis drugs on genito-urinary tuberculosis

Tayssir Gabbour

Department of Urology, Riyadh National Hospital, Riyadh, Saudi Arabia

32 cases of scrotal contents tuberculosis (T.B.), 20 cases of urinary tract tuberculosis, diagnosed and treated between 1981-1986. Epididymis was involved in scrotal T.B., unilateral in 30%, bilateral in 70%, multiple nodule in 95%, single in 5%. In 10% testicles was involved unilaterally one case of scrotal fistula in 3 cases urinary tract and epididymis were involved together.

In urinary tract T.B. all cases involved kidney, ureter, bladder. All cases of urinary tract and scrotal were proved by biopsy.

All scrotal cases treated conservatively with 3 anti T.B. drugs healed completely without any palpable residual disease. On the other hand, all cases of urinary tract T.B. did not improve functionally and morphologically on anti T.B. drugs alone.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Re-enter the dragon: The reappearance of tuberculosis

H. M. Du Preez, G. Ismail

Department of Urology, Armed Forces Hospital, Khamis Mushayt, Saudi Arabia

For some years now, urogenital tuberculosis seemed to have virtually disappeared from the urological map. However, together with the renaissance of the disease in other organs, urogenital tuberculosis is once again becoming a fact of clinical life.

Since the beginning of 1995, there have been more patients with tuberculosis seen in the Urology Department at Armed Forces Hospital, Southern Region, than during the entire four years period from 1990 to 1994.

Diagnosis has not always been entirely straightforward, despite the availability of contemporary imaging techniques, and, in a manner of speaking, errors both of commission and omission have occurred.

The case records, diagnostic images and histological slides of 9 patients managed in our urology service have been reviewed. Seven suffered from tuberculosis, and in the other two, this disease was considered to be a strong diagnostic probability; to some extent, this delayed the correct diagnoses, although, in the long term, the patients sustained no harm.

In five of the patients, the disease was sufficiently far advanced as to require excisional surgery, including 2 nephrectomies, and or orchidectomy and 2 epididymectomies.

Tuberculosis is once more merging from the wings to occupy a position on the clinical stage, and after a very long period of clinical complacency about this disease, as urologists, we should once more become alert to TB as a diagnostic entity to be taken seriously.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Brucella epididymo-orchitis

A. Ibrahim, S. D. Shetty, K. P. Patil, R. Awad, N. E. Bilal

Departments of Urology and Microbiology, College of Medicine, King Saud University and Asir Central Hospital, Abha, Saudi Arabia

Brucellosis is endemic in various regions of Saudi Arabia including the south-western region of Assir. Since January 1986, 15 patients with epididymo-orchitis (EO) with raised brucella titre (more than 1:160) were seen in our Department. These 15 patients were compared to a similar number with non-specific EO regarding the onset, duration of illness prior to admission, pattern of fever, associated lower urinary tract symptoms, testicular versus epididymal involvement, urinalysis, urine culture, leucocyte count, ESR, IVU and response to treatment.

There were 12 Saudis and 3 Non-Saudis in the brucella group all of whom gave history of consumption of raw milk. The onset was insidious and the duration was significantly longer (mean 21.7 days) as compared to acute non-specific EO (mean 5.9 days). 7% of the brucella patients and 80% of the non-specific group had lower urinary tract symptoms. The degree of inflammation was markedly less in brucella patients as compared to the non-specific group. There was a significant difference between the leucocyte count in the two groups. Urography showed a significantly higher number of abnormalities in the non-specific group.

Brucella serology should be a routine investigation in all cases of EO in endemic areas as it is a distinct entity.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Clinical profile of brucella epididymo-orchitis in hafr al batin region (a retrospective study of 5 years)

Ghulam Jeelani

Department of Urology, King Khaled General Hospital, Hafr Al Batin, Saudi Arabia

Brucellosis is a relatively common disease in this region since majority of the people in and around the Hafr Al Batin region are bedouin living in the deserts and deal with all types of livestock as the source of their livelihood. While all types of clinical manifestation of this disease are seen, Epididymo-orchitis due to this disease is not an uncommon disorder in our urological practice. While as overall incidence of about 5% of Epididymo-orchitis was seen in cases of Brucellosis during this period the overall incidence of Brucellosis-orchitis in urological practice is less than 1%.

Though mainstay in diagnosis of this entity is high clinical suspicion and positive agglutination test for Brucella in titre of 1:160 or more. Serum negative disease is occasionally seen.

Natural history, clinical presentation, treatment prognosis and preventive measures of this unusual urological clinical entity is discussed.

Presented at the: 8th Saudi Urology Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Value of imaging in urinary tract infection

Adil Jamal, A. Wassia

Department of Urology, King Khalid National Guard Hospital, Jeddah, Saudi Arabia

Inflammation of the urinary tract represents an unusually difficult and often frustrating problem for the urologist and the radiologist alike. This is disturbing because delayed diagnosis is associated with prolonged morbidity and frequently leaves no alternative but to remove an irreversibly damaged non-functioning kidney.

Early and accurate diagnosis, on the other hand, allows intensive parenteral antibiotic therapy with or without drainage. The results, at times, in complete anatomical and functional recovery of the organ. The diagnostic application and clear demonstration of the pathologic process through improved conventional urographic studies and computerized tomography is an important step to this end.

This presentation documents the diagnostic accuracy of our uro-radiology investigations and how imaging has guided our decision in the management of urinary tract in infections.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Xanthogranulomatous pyelonephritis: A retrospective study of 10 cases and review of the literature

A. Fallatah, M. Tarakji, J. Amuesi

Departments of Urology and Pathology, King Fahd Hospital, Jeddah, Saudi Arabia

We herewith report 10 patients with Xanthogranulomatous pyelonephritis (XGP) who were treated in our department between the years 1988 and 2000. The patients’ age ranged from 20 to 60 years (mean 45 years), there were seven males and three females giving a male-female ratio of 2.3:1. 60% of the patients were over 50 years old. The lesion was unilateral in all cases and pyonephrosis was found in seven patients. Nine cases had associated renal stones (90%), which led to non-functioning kidney in all these cases. Two cases had associated fistulae (one uretero-colonic fistula and one reno-cutaneous fistula). One case of focal XGP was found to be associated with renal cell carcinoma while a second patient with diffuse obstructive type of XGP and renal stone had associated transitional cell carcinoma of the renal pelvis. In all patients, the urine culture was negative. Pus culture revealed Escherechia Coli in four cases (40%), Salmonella Para B in one, and no organism could be grown in four other cases. One case did not have any pus formation. All patients were treated with nephrectomy.

Presented at the: 15th Saudi Urological Conference King Fahd Hospital – Madinah Al Munawarah 7-9 May 2002 (24-26 Safar 1423)

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Eosinophilic cystitis: A case report and review of literature

A. Ammari, A. Tayib, J. Al Maghrabi, A. Bazeem, H. Mosli

Department of Urology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Eosinophilic cystitis is a rare inflammatory disorder of the urinary bladder. The clinical presentation and the radiological appearance may mimic bladder cancer.

A 55 years old female presented to us with painful gross hematuria and lower urinary tract irritative symptoms. Urethro-cystoscopy showed irregular polypoid mass with hyperemic mucosa. Biopsies were taken. Histopathological examination revealed polypoid eosinophilic cystitis. Patient responded well to bladder irrigation with steroids and oral antihistaminic. Review of the literature indicated that the disease may occur at different age groups, in children's it is short lived and self-limited. Many factors may predispose to eosinophilic cystitis. Medical treatment is sufficient in most of the case, but surgical intervention other than diagnostic TURBT may be indicated in rare reported cases.

Presented at the: 15th Saudi Urological Conference King Fahd Hospital – Madinah Al Munawarah 7-9 May 2002 (24-26 Safar 1423)

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Interstitial cystitis: Saudi experience

M. S. Tarsin, W. Al Dughiman

Department of Urology, Central Hospital, Riyadh, KSA

Introduction: Interstitial cystitis is a complex, chronic bladder disorder of unknown etiology. Severe progressive irritative symptoms, frequency, urgency, nocturia, severe dysuria and suprapubic pain characterize it. Symptoms may improve slightly after voiding. Although no strict definition of the disease exists, the etiology remains controversial and poses a diagnostic and therapeutic challenge to the urologists. Cystoscopic examination and hydrodialation under general anesthesia is part of the National Institute of Health diagnostic criteria. Interstitial cystitis has been widely regarded as wastebasket diagnosis, but there is extensive support in the literature for the validity of the entity, at least as a clinical condition.

Materials and Methods: Nineteen patients diagnosed with I.C. at Riyadh Medical Complex between 1992 and 1998. All these patients met the National Institute of Health symptom criteria. Patient's evaluation included urine analysis, culture and sensitivity, culture for acid-fast bacilli and urine cytology. KUB, US and voiding cystouretherogram. Cystoscopic examination under GA, hydrodialation and bladder biopsy revealed no I.C. in two patients. Histopathologic examination revealed one case of eosinophylic cystitis.

Treatment: Sixteen patients their diagnosis with I.C. was confirmed cystoscopically and histologically. Our treatment is based on vesical hydrodialation, bladder training, instillation of Dimethyl sulfoxide (Rimso-50), or silver nitrate. Systemic medical treatments with sodium pentosanpolysulfate, amytryptiline and/or oxybutinin. Two failed all medical treatments and have severely contracted bladder-required surgery that was refused by the patients.

Results: One patient was excluded, found to have eosinophylic cystitis. 13/18 (72%) was treated with instillation of 50% Dimethyl sulfoxide (RIMSO-50), only 8 patients 68% showed significant improvement for over than 24 months. Three 23% were treated with silver nitrate and repeated hydrodilation their symptoms improved especially during night. Two 15.3% with severely contracted bladder refused surgery. 5/18 (27.7%) preferred medical treatment, two were treated only with Ditropan 5 mg, one responded well to Pentosanpolysulfate and two were placed on Amytriptiline.

Conclusion: Interstitial cystitis is not so uncommon in Saudi Arabia and so little is understood about this condition that patients may never get correctly diagnosed. About 2/3 of patients with classical symptomatic I.C. have achieved significant benefit from (Rimso-50) therapy. In few patients the lesions completely resolved.

Presented at the: 12th Saudi Urology Conference Al Hada and Taif Armed Forces Hospitals Program 23-25 February 1999 (7-9 Dhu Al Qa’dah 1419)

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Spectrum of cystoscopic and light microscopic changes in patients with persistant cystitis syndrome

Ammar A. Ghobish

Department of Urology, Al Amen Hospital, Taif, Saudi Arabia

Painful bladder syndrome or persistent cystitis syndrome is probably a complex group of disease manifested by bladder (SP) pain, irritative voiding symptoms with negative urine culture. In this work, cystoscopic and light microscopic spectrum of changes in those patients were studied.

Subjects and Methods: All adult male and female who fulfilled the following criteria were included: Presence of symptom complex of suprapubic pain, dysuria frequency and nocturia for more than 3 months and repeated urinalysis and culture including specific media for tuberculosis and fungus were negative. Full investigations were done including cystoscopy with hydrodistention and multiple bladder biopsies that processed for light microscopy.

Results: This study included 51 patients (39 males and 12 females). The age ranged from 22 years to 64 years. Variable endoscopic finding were seen and in many cases only after bladder distention, cracked mucosa, some bilharzial lesions and small polypoid masses. In some males the only finding were in the posterior urethra e.g. adhesion between 2 prostatic lobes and villous growth from veru. Light microscopic changes were variable including hyperplastic/dysplastic transitional epithelium, chronic inflammatory cell infiltration, Brunn nest's, cystitis gladularis, squamous metaplasia, bilharzial reaction and some picture characteristic of interstitial cystitis. In situ carcinoma was found in 3 cases, inverted papilloma in one case and nephrogenic adenoma in one case.

Conclusion: Persistent cystitis syndrome was present in both males and female. They had very variable endoscopic and histopathologic findings including CIS, which mandates both routine endoscopy and bladder biopsies. The finding characteristics of interstitial cystitis were found in both males and females, which necessitates bladder distention to be done routinely in both males and females with this syndrome.

Presented at the: 12th Saudi Urology Conference Al Hada and Taif Armed Forces Hospitals Program 23-25 February 1999 (7-9 Dhu Al Qa’dah 1419)

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Terazosin and cystoscopy differentiate between 2 subsets of patients with prostatodynia/non-inflammatory chronic pelvic pain

T. Ghobish

Department of Urology, Suez Canal University Hospital, Ismailia, Egypt

Introduction and Objective: Prostatodynia (PD)/non-inflammatory chronic pelvic pain in males is one of the most difficult syndromes urologists have to manage. It is characterized by pain, voiding and sexual symptoms. The putative etiology ranges from unknown infectious agent and voiding dysfunction to misdiagnosed interstitial cystitis. In this study we examine if Terazosin and diagnostic cystoscopy and hydrodistention under general anesthesia (Dx. Cyst. + HD) would identify subgroups of patients.

Subjects and Methods: Prospective study of 67 patients with PD were done. Each patient received 2-5 mg Terazosin daily for 3 months. The responders (who had improved symptoms and satisfied with the treatment) and non-responders were identified. All patients advised for Dx. Cysto. And the outcomes were analyzed.

Results: Forty-four patients were identified as responders and 23 patients were identified as non-responders. Of the responder group, 24 patients had undergone Dx. Cysto. + HD and 3 patients only showed petechea all through the four quadrants of the bladder. All 23 patients of the non-responders group were undergone Dx. Cysto. + HD. 21 patients showed the characteristic 4-quadrant bladder petechea on hydrodistention.

Conclusion: Patients diagnosed with PD present a heterogenous group. Interstitial cystitis may be misdiagnosed in males as PD. Terazosin test and Dx. Cysto. + HD, identified 2 subgroups of patients. These diagnostic work up may have impact on treatment of these patients.

Presented at the: 14th Saudi Urological Conference King Fahd Military Medical Complex – Dhahran 13-15 February 2001 (19-21 Dhu Al Qa’dah 1421)

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Fournier's gangrene: The changing face of the disease

R. J. Yaghan, T. M. Al Jaberi, I. Bani-Hani

Department of General Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan

Purpose: To review our experience with Fournier's gangrene and compare it with the experience of others. This might help in explaining some of the changing epidemiological features.

Methods: Ten cases of Fournier's gangrene were treated at our center between 1997 and 1998 by orthodox method: aggressive resuscitation, triple antibiotics and urgent surgery. Relevant epidemiological aspects will be discussed.

Results: the median age was 48.5 years with a range from 24 to 64 years. Male:Female ratio was 9:1. The average duration of symptoms prior to presentation was 6.2 days. Seven patients (70%) were diabetics. The average hospital stay was 3.2 weeks. The underlying etiology was anorectal, urogenital and cutaneous in 40%, 30% and 30% of the cases, respectively. The average number of surgical procedures per one patient was 2.1. Mortality rate was 20%.

Conclusion: Our epidemiological data harmonize with the changing face of Fournier's gangrene in that the disease is affecting both sexes with a wide range of ages, has a more insidious onset, and is not idiopathic. Population aging worldwide – as a result of the improving health care and therefore the increasing prevalence of associated medical disorders may explain these departures from the original description of Fournier's gangrene. These factors may also explain the consistently high mortality rate over the years masking any survival benefits from improved medical care. The better understanding of the pathophysiology has reduced the ratio of idiopathic cases to a minimum. Perianal infection is currently the commonest etiology.

Presented at the: 13th Saudi Urological Conference Riyadh Armed Forces Hospital 14-17 February 2000 (09-12 Dhu Al Qa’dah 1420)

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Superiority of semen pcr over urine PCR for detection of genito-urinary tuberculosis

Magdy S. ElBahnasawy1,2, E. Elsawy1,2, O. Moussa1,2

1Department of Urology, Almoosa General Hospital, Al Hasa, Saudi Arabia, 2Department of Urology and Microbiology, Nephrology Center, Mansoura University, Mansoura, Egypt

Introduction and Objective: Persistent LUTS especially in the presence of ejaculatory symptoms arouse the suspicion of genitourinary TB. We want to test our hypothesis that in suspected cases of genitourinary TB, it is better to search for it in semen rather than in urine. 60 male patients with persistent LUTS together with patients with painful or secondary premature ejaculation were enrolled in this study. Their mean age was 39.4 ± 8.7 years while the mean duration of their complaint was 15.4 + 4.8 months. Patients were subjected to thorough history taking and physical examination including DRE. Patients were extensively investigated by urinalysis, urine culture, Ziehl Nielsen (Z.N.) staining and PCR for acid fast bacilli in both urine and semen, semen culture, semen culture for TB, TRUS (+ biopsy) and/or cystoscopy when indicated in addition to PSA determination in all men above 50 years old.

Results: Significant physical findings included BPH (15), epididymal mass (1), recurrent epididymo-orchitis (1), scrotal sinus (1) and prostatic carcinoma (1). Urine PCR for TB was positive in 5 patients (13% sensitivity and 100% specificity) while same test in semen yielded astonishingly high incidence of TB in 40 patients (100% sensitivity and 91% specificity). Semen culture for TB confirmed its presence in 38 out of 40 PCR post specimen. TRUS findings showed calcular prostatitis (7), BPH (15), Prostatic adenocarcinoma (1) and pathologic seminal vesicles (15). UTI was proved by urine culture in the other 20 cases with E-coli strains predominantly isolated.

Conclusions: In our locality genitor-urinary TB is prevalent among this group of patients. PCR in semen is highly sensitive and specific test which should be done whenever genitourinary TB is suspected as it showed better sensitivity than same test in urine.

Presented at the: 19th Saudi Urological Conference King Khalid University Hospital – Riyadh 26 February – 01 March 2007

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Detection of human papilloma virus infection by hybridization test in prostatic biopsies

H. Mosli, F. Gazzaz, T. Al-Mouhissen

Department of Urology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Objective: To find a clearer picture on the relationship between HPV and between prostate cancer and benign prostatic hyperplasia in the Saudi population, and compare it with some western data.

Patients and Methods: A prospective study, was conducted at King Abdulaziz University Hospital (KAUH) during the period from March 2007 to December 2008 on a total of 56 male patients (n = 56), range of age 50-93 years (average 68), diagnosed as having prostate cancer or benign prostatic hyperplasia. HPV DNA Hybridization by Hybrid Capture 2 (HC2) was performed on prostate biopsies of these patients to detect HPV infection.

Results: The tissue of all the prostatic biopsies was negative for HPV DNA when examined by the highly sensitive technique, Hybrid Capture 2 (HC2) test for the detection of HPV infection (100.0% of cases negative).

Conclusion: Data from our current research at KAUH in Jeddah indicated absence of HPV DNA in several samples of the examined prostatic tissues of patients diagnosed as having prostate cancer or benign prostatic hyperplasia. Therefore may be it is also the reason why the incidence of prostate cancer is low in Saudi Arabia.

Presented at the: 21st Saudi Urological Conference North West Armed Forces Hospital – Tabuk 14-16 April 2009

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Urinary tract infections with extended spectrum beta-lactamase producting organisms in a tertiary care hospital: Risk factors and antibiotic sensitivity profile

W. Fawzy, N. Al-Dossary, E. Madani, M. Gomha, H. Abdelhadi, S. Al-Bunayan, A. Al-Dayel

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Objective: Extended spectrum beta-lactamase (ESBLs) producing organisms are now a worldwide problem. Aim of this work is to study prevalence and elaborate on the clinical correlations of ESBLs in terms of common risk factors, clinical presentation and antibiotic sensitivity profiles in KFSH-D.

Materials and Methods: We reviewed all medical records of patients with urine culture showing significant growth (>105 cfu/ml) of ESBLs organisms during the year 2008. The records were reviewed to determine the prevalence of these organisms, risk factors, clinical presentation and antibiotic sensitivity profile. These were 56 females (56%) and 44 (44%) males with a mean age ± SD of 49 ± 23 years (range 1.4-92.8). A positive culture event for ESBLs is defined as any significant growth for one individual organism >105 colony forming unit/ml (cfu/ml). In specimen growing more than one ESBLs organism (up to a maximum of 3), each organism is considered as individual positive culture event.

Results: A total number of 162 positive urine culture events for ESBLs (100 patients) were found between January 1st and December 31st, 2008, accounting for 13.4% of all positive urine culture events (3.1% of all urine specimen). These include E-coli in 82.1%, Klebsiella species 14.8%, proteus mirabilis in 1.2%, enterobacter in 0.6%, Morganella Morganii in 0.6% and providencia stuartii in 0.6%. The prevalence of these organisms is not different among males and females. Pediatric population (<16 years) have lower prevalence of Klebsiella species compared to adults, 5.6% vs. 14.6 respectively. Klebsiella is less prevalent in outpatient population (5.9%) compared to compared to inpatients and emergency room, 16.2% and 17.1% respectively. The commonest risk factors were found to be uncontrolled DM (31%), indwelling catheter (28%), antibiotic use prior to positive culture event (28%), bladder outflow obstruction (15%) and neuropathic bladder (14%). Many patients had more than one risk factors. Fifty percent of positive ESBLs specimens occurred in patients with lower urinary tract symptoms (LUTS) without fever, while 29% of the positive urine culture events were associated with febrile urinary tract infection. 21% of the positive culture events with ESBLs were not associated with any symptoms. All organisms are resistant to all penicillins and cephalosporines, while they are all sensitive to imipenem and moropenem except one. The highest sensitivity among other groups of antibiotics include Tazocin and Amikacin with 81% each, followed by Cefoxitin (74.1%), Nitrofurantoin (69.2%), Gentamycin (52.7%), Tobramycin (37.4%), Bactrim (24.8% and Ciprofloxacin (17.5%).

Conclusion: Irrational use of antibiotics especially third generation cephalosporins and presence of indwelling urinary catheters are the major avoidable risk factors for ESBLs urinary infection. Meropenem and Imipenem should be the antibiotics of first choice in the treatment of ESBLs.

Presented at the: 21st Saudi Urological Conference North West Armed Forces Hospital – Tabuk 14-16 April 2009

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Urinary tract infection in a tertiary care hospital during 2008: An epidemiological review of microbiological trends

E. Madani, N. Al-Dossary, W. Fawzy, M. Gomha, H. Abdelhadi, S. Al-Bunayan, A. Al-Dayel

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Objective: To review the prevalence of urinary tract infection among all urine samples submitted for culture from January 1st to December 31st 2008, and to study the microbiological trends in relation to patients’ demographic data.

Materials and Methods: We retrospectively reviewed the results of all urine specimens processed for culture during 2008 to identify the prevalence and microbiology of positive cultures, and to study its relation to patients’ age, gender, and specimen collection method and the inpatient/outpatient status at that time. A positive culture event is defined as any significant growth for one individual organism >105 colony forming unit/ml (cfu/ml). In specimen growing more than one organism (up to a maximum of 3), each organism is considered as individual positive culture event.

Results: Between January 1st and December 31st, 2008, a total number of 5039 urine specimens (2768 patients) were submitted for urine culture. Out of these specimen, 1061 (21.1%) were +ve; 931 were +ve for one organism and 130 (12.3%) were positive for more than one organism accounting for a total of 1209 positive culture events. The commonest organisms included E.coli (44.3%), Klebsiella (12.2%), pseudomonas (11.8%) and enterococcus (8%). Among the whole +ve events extended spectrum beta lactamase (ESBL) producing organisms were found in 13.4% while the multidrug resistant organisms (MDRO) were found in 2.4%. 43.3% of +ve culture were found in male patients, whereas 56.7% were found in females. Comparing the prevalence of different organisms in pediatric and adult groups, we found E.coli (47.2 vs. 43.85) and pseudomonas (16.7 vs. 11.2%) were somewhat higher rates in pediatric group while Klebsiella (9.0% vs. 12.6%) and streptococcus species (0.7% vs. 4.2%) were more in adults. Comparing males to females, male patients have more pseudomonas (17% vs. 7.9%) while females have more E.coli (33.8% vs. 52.3%) in positive culture events. The pattern of infection in specimens collected from inpatients was distinct from outpatients, with E.coli accounting for 51.9% and 37.2% for outpatients and inpatients respectively. Streptococcus species follows a similar pattern as E.coli with 6.8% for outpatients and 1.5% for inpatients. On the other hand pseudomonas showed 16.3% among inpatients and 8.7% among outpatients. Candida species was more prevalent in I.C.U. patients as compared to other inpatients (26.6% vs. 5.4%). Indwelling urinary catheters are associated with growth of more than one organism that was found in 40.2% of specimens in this group.

Conclusion: There is a trend for resistance to antibiotics as evident by a high rate of ESBLs. The urinary tract infection pattern among inpatients and ICU showed more pseudomonas and candida infection, compared to outpatients and reflect the increasing use of a broader spectrum of antibiotics and indwelling urinary catheters.

Presented at the: 21st Saudi Urological Conference North West Armed Forces Hospital – Tabuk 14-16 April 2009

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Multidrug resistant organisms in urinary tract infection in a tertiary care hospital: Epidemiologic study and antibiotic sensitivity trends

N. Al-Dossary, W. Fawzy, E. Medani, M. Gomha, H. Abdelhadi, S. Al-Bunayan, A. Al-Dayel

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Objective: There is increasing trend for resistance to antimicrobials all over the world. Urinary tract infection due to multidrug resistant organisms (MDRO) is a challenging problem. In this study we determined the prevalence of these organisms, risk factors and antimicrobial sensitivity profile.

Materials and Methods: We reviewed all medical records of patients with urine culture showing significant growth (>105 cfu/ml) of multidrug resistant organisms during year 2008 to determine the prevalence of these organisms, risk factors, clinical presentation and antibiotic sensitivity profile. These were 5 females (24%) and 16 (76%) males with a median age of 40.1 years (range 0.26-82.7).

Results: A total number of 29 positive urine culture events for MDRO (21 patients) were found during the year 2008 accounting for 2.4% of all positive urine culture events. These include pseudomonas aeruginosa in 16 (55.2%), acinetobacter baumanii in 7 (24%) and some enterobacteriacae in 6 (20.8%). Among the 29 positive MDRO, all 7 Acinetobacter were seen in males while Pseudomonas was seen in 66.7% and 52.2% of positive events in females and males respectively. Among the 7 Acinetobacter MDRO, none was observed in outpatient urine specimens, while pseudomonas MDRO was seen in outpatient, inpatient, emergency and ICU with comparable rates. The most common risk factors for developing MDRO were presence of indwelling urinary catheters in 81%, intermittent catheterization in 14.3%, use of recent antibiotic courses in 72%, advanced malignancy in 38.6%, immobility (bed-ridden) in 33%, neuropathic bladder (19%), uncontrolled diabetes mellitus in 10% and immune suppression (5%). More than one factor can be present in one patient. In 48.3% of positive culture events, patients presented with lower urinary tract symptoms without fever while in 27% there was febrile urinary tract infection and in 24% patients were asymptomatic. Among antibiotics panel, pseudomonas was sensitive to polymyxin in 91%, Tazocin in 56%, Imipenem and Meropenem in 23%, Colistin in 18.7%, Amikacin in 14.3%, Piperacillin in 13.3%, Ciprofloxacin in 12.5% while completely resistant to Cefipime and Ceftazidime. Acinetobacter was sensitive to polymyxin in 100% and tobramycin in 85.7% while it showed complete resistance to all cephalosporines, piperacillin and ciprofloxacin.

Conclusion: MDRO infection can be on minimized by decrease of use of indwelling urinary catheters and proper use of antibiotics. Treatment may need combination therapy and may need to address the use of polymyxin.

Presented at the: 21st Saudi Urological Conference North West Armed Forces Hospital – Tabuk 14-16 April 2009

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Minimally invasive treatment of abscesses in urological practice

Ali Al-Abbad, Mohamed A. Gomha, Adel Al-Dayel

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Introduction: Traditional treatment of abscess is open surgical drainage. In this work, we reviewed our experience in management of urological abscesses utilizing minimally invasive methods.

Methods: We reviewed our data base between December 2007 and December 2009 to identify patients who had abscesses related to urinary tract and treated by minimally invasive modalities. The medical records of these patients were reviewed as regards to mode of presentation, associated comorbidities, diagnosis methods, management and outcome.

Results: Five (5) patients, four (4) males and 1 female, were diagnosed with abscesses related to urinary tract and treated by methods other than open surgery. Age range was between 32 and 59 years. These included prostatic abscess in 2, multiple renal abscess in 1, psoas abscess communicating to obstructive pyelonephritis in 1 and pelvic abscess post-radical cystectomy in 1. Three (3) patients were diabetic and one had neuropathic urinary bladder. Ultrasound and CT were the tools utilized for diagnosis. Three (3) patients were managed by percutaneous needle aspiration that included 1 with multiple prostate abscess, 1 with multiple renal abscesses and 1 with pelvic abscess. The patient with psoas abscess communicating to obstruction pyelonephritis was managed by Double J stent insertion and the patient with small prostatic abscess was treated only by antibiotic treatment. Patients were followed up with a median duration of 7 months (range 4–32) and all were doing fine with CT imaging showing resolution of abscess.

Summary and Conclusion: There is a role of minimally invasive methods for different abscess related to urinary tract especially in high risk patients.

Presented at the: 22nd Saudi Urological Conference King Faisal Specialist Hospital and Research Centre 15-18 March 2010

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Two steps penile skin reconstruction after silicone injection granulomatus reaction

Khalid Al Rumaihi, Abdulla Rashid Al Naimi, Ahmad Shamsodini, Riadh Taleb, Haidar Mohsen, Tawiz Gul

Department of Urology, Hamad Medical Corporation, Doha, Qatar

Introduction: Silicone injection, liver oil and many other materials are used for increase in penile girth. Unfortunately, it is associated with high rate of complications including migration of the materials used and deformity of the organ and severe tissue reaction and sometimes necrosis of the tissue. We present the two steps penile skin reconstruction following silicone, and fish oil injection.

Aim: To discuss the options of reconstruction of penile skin after complication of silicone, fish oil injection of penis.

Methods: 10 patients presented to our center after injection of various types of material to penile skin in order of augmentation of penile shaft. All the injections were given by non medical personal in the laborer camp. They presented with various complication of penile skin ranging from edema and paraphimosis, abscess formation and necrosis to granulomatus reaction of the skin.

Results: Treatment ranged from drainage of abscess and excision of necrotic tissue to total excision of the penile tissue. The skin defects were covered with two stages scrotal flap reconstruction. The patient had a satisfactory sexual activity and satisfactory length of the penis was preserved.

Summary and Conclusion: The scrotal skin flap can be used in totally lost penile shaft skin with satisfactory results.

Presented at the: 22nd Saudi Urological Conference King Faisal Specialist Hospital and Research Centre 15-18 March 2010

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Isolated renal hydatid disease: A report of 6 cases and review of the literature

Ahmed Al Sayyad, Alaa Mokhtar, Hindi Al-Hindi, Waleed Al Khudair

Department of Pathology and Laboratory Medicine, and Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Objective: To present a single institution's experience with the diagnosis and management of six (6) cases of isolated renal hydatid disease.

Materials and Methods: We reviewed records of patients with isolated renal hydatid disease treated in our institution over the past 20 years (1989–2009). This includes demographic, clinical, radiological and pathological data.

Results: Out of the 119 cases treated for hydatid disease, 6 (3 male, 3 female) were found to have isolated renal involvement (5%). Their median age was 46.5 years (range 28 to 40 ?± 13.7). Five (5) cases presented with flank pain (83%) and one case was asymptomatic. No cases presented with hydaturia. Eosinophilia was seen in four cases (67%), indirect hemaglutination test (IHA) positivity in 4 of 5 cases (80%). Computerized tomography showed complex renal cyst in 4, soft tissue mass with heterogenous enhancement in 2 and calcifications were evident in 5 cases. Both kidneys are equally involved. No patient had bilateral renal involvement. Four (4) cases were treated by total nephrectomy and 2 by partial nephrectomy. The entire kidney was involved in one case, upper role in 2, and lower pole in 3. Patients were followed up for a period that ranged from 0.4 to 11.3 (median 7.3 ± 3.8 years) with no evidence of recurrence.

Conclusion: Isolated renal hydatidosis is a rare entity and the main challenge is its preoperative diagnosis. Clinical, serologic and radiological studies cannot confirm the diagnosis, and pathological examination after surgical removal can confirm the diagnosis. So, hydatid disease should be considered in the differential diagnosis of space occupying lesions of the kidney.

Presented at the: 22nd Saudi Urological Conference King Faisal Specialist Hospital and Research Centre 15-18 March 2010

Urol Ann. 2016 Apr;8(Suppl 2):S163–S179.

Surgical management of lymphoedema of genitalia

Abdulla Al Naimi, Abdulla Al Ansari, Ahmad Shamsodini, Khalid Al Romahi, Riad Talib

Department of Urology, Hamad Medical Corporation, Doha, Qatar

Introduction: Lymphoedema arises from the abnormal retention of lymphatic fluid in the subcutaneous tissues as a result of lymphatic obstruction. Genital lymphoedema can occur in isolation with the scrotum, penis or both being involved or it can be combined with generalized lower limphoedema. Common causes of secondary genital lymphoedema are surgical interventions and trauma, radiotherapy, malignant infiltration, venereal diseases and parasitic infections all involving the inguinal lymph nodes. We present surgical management of a case of lymphoedema secondary to filariasis disease.

Materials and Methods: The main complaint of the patient was buried penis and heaviness of scrotum and disturbed during voiding because of spreading of the urine over his genitalia. The patient had one attempt of reduction scrotoplasty two years back that did not give him satisfactory results. He revised full course of antifilariasis medication and had lympho drainage treatment that did not help him to reduce the scrotomegaly. The patient had total anterior scrotectomy, removing the skin and dartus layer, preserving the lateral aspect of the scrotum for neo-scrotoplasty. Taking in consideration the lymphatic drainage of the genitalia the lateral aspect of the scrotum and the prepuce was not involved in the disease.

Results: The patients had smooth postoperative course with satisfactory penile length and the new scrotum was expanded gradually that gave the patient satisfactory sexual activity.

Conclusion: Surgical lymphoedema of genitalia should be considered after failure of medical and physiotherapy. The best result can be achieved by total scrotectomy and removal of the subcutaneous layer and creation of new scrotum using the lateral scrotal flaps.

Presented at the: 23rd Saudi Urological Conference King Fahd Specialist Hospital – Dammam 21-24 February 2011

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