Background: In Egypt, where bilharziasis is endemic, bladder cancer is the commonest cancer in males and the 2 nd in females; squamous cell carcinoma (SCC) is the commonest type found, with a peculiar mode of presentation. The aim of this study is to identify and rank the risk factors of muscle invasive bladder cancer (MIBC) in Upper Egypt and describe its specific criteria of presentation and histopathology.

Introduction and aims: Being best-studied superficial bladder cancer (SBC) chemopreventives, retinoids' negative studies and toxicity were stumbling. With proper understanding of retinoid metabolism, we aimed at investigating combined ketoconazole (a strong inhibitor of retinoic acid-catabolizing cytochrome P450s) all-trans retinoic acid (Keto-atRA) SBC treatment. VEGF and TGFα levels are end-point pathogenetic biomarkers involved in early SBC.Results: Keto-atRA treatment significantly improved survival time and decreased recurrence rate compared to control disease group, with tolerable and reversible side-effects. Treatment normalized induced levels of VEGF and TGFα with a positive correlation between these cytokines.Material and methods: Seven days after TURT visible tumor(s), combined atRA 1 mg/kg for five days a week + Keto 200 mg twice daily for five days a week for three months were given to 16 patients with SBC stages Ta and T1 with various grades. Three months follow up/20 months used white light cystoscopy and urinary cytology. Recurrence rate and survival time were compared to a retrospective group of 25 patients of comparable age, stage and grade with TURT as sole treatment for SBC. VEGF and TGFα were measured in urine and serum of 12 normal subjects and treated patients. Samples were collected just before TURT, one week after TURT, at the end of one month and at the end of three months of treatment.Conclusions: The combination and schedule used for KetoatRA therapy effectively reduced recurrence rate and increased survival time of SBC patients probably through reduction of VEGF and TGFα as major mitogenic/angiogenic factors; possibly by eliminating malignant cells that produce them.

Introduction: The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ureteral stones is around 81% when treated by either SWL or ureteroscopy (URS).

We evaluated the effect of varicocelectomy on semen parameters and levels of sperm DNA damage in infertile men. A total of 75 infertile men with varicocele and 40 fertile men (controls) were included in this study. Semen analysis and sperm DNA damage expressed as the DNA fragmentation index using acridine orange staining and chromatin condensation test by flow cytometry were assessed before and 6 months after varicocelectomy. The patients were also followed up for 1 year for pregnancy outcome. Semen parameters were significantly lower in varicocele patients compared to controls (P < 0.05). Mean percentages of sperm DNA fragmentation and sperm DNA chromatin condensation in patients were significantly higher than those in controls (P < 0.05). After varicocelectomy, sperm DNA fragmentation improved significantly, whereas sperm chromatin condensation was not significantly changed. In 15 out of 75 varicocele patients, clinical pregnancy was diagnosed; those with positive pregnancy outcome had significant improvement in sperm count, progressive sperm motility, and sperm DNA fragmentation, but there was no significant difference in sperm DNA condensation compared to negative pregnancy outcome patients. We concluded from this study that acridine orange stain is more reliable method than flow cytometry in the evaluation of sperm DNA integrity after varicocelectomy.

The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.