Objective: To determine the relative importance of clinical presentation, laboratory studies, and ultrasonography in the diagnosis of acute scrotum, and to suggest an effective method of management. Subjects and Methods: Forty patients who were hospitalized between January 2002 and December 2002 for acute scrotum were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. Results: Epididymitis (n = 24) was the commonest cause of acute scrotum followed by testicular torsion (n = 11), torsion of testicular appendages (n = 4), and idiopathic scrotal edema (n = 1). Both mean age (40.7 vs. 13.8 years), and average duration of pain at presentation (4.5 days vs. 19.1 h) were higher in patients with epididymitis than in torsion. Onset was usually insidious in epididymitis, sudden in testicular torsion, and variable in torsion of testicular appendages. The majority (87.5%) of patients with epididymitis were managed conservatively. The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion, but was good in epididymitis. Conclusion: Our results show that a careful clinical evaluation, by an experienced examiner, provides the correct diagnosis in acute scrotum rather than ultrasonography. It is of utmost importance to exclude testicular torsion in those who are younger than 16 years and whose pain duration is less than 24 h.

Objective: To report a case of bilateral emphysematous pyelonephritis (EPN) and emphysematous cystitis in a 64-year-old diabetic male with autosomal-dominant polycystic kidney disease (ADPKD). Case Presentation and Intervention: A 64-year-old diabetic male presented with worsening of renal function and fluid overload. Diagnosis was confirmed by computerized tomography (CT scan) and conservative management with broad-spectrum antibiotics was instituted. There was good clinical response and repeated CT scan showed complete resolution. Conclusion: This case shows that conservative management is an acceptable alternative to surgery in EPN occurring with ADPKD. However, it is recommended that patients should be closely monitored, both clinically and radiologically, and percutaneous catheter drainage or surgical intervention carried out whenever deemed necessary.

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We present our experience with a new technique of real time 3-dimensional sonography -- "4-dimensional Transrectal ultrasound (TRUS)" guided prostate biopsy. A total of 64 patients suspected of having prostate cancer based on an elevated prostate-specific antigen (greater than 4 ng/ml) formed the study group. A voluson (General Electric Vivid 3) ultrasound machine equipped with a transrectal 5-8 MHz curvilinear transducer was used. Sonography-guided prostate biopsy was performed following prostate imaging and volume calculation using 3D and 4D imaging. Biopsies of tumor suspicious areas, if present, as well as random biopsies were done. Histopathology showed prostate cancer in 15 (23.4%) and benign prostatic conditions in 49 (76.6%). TRUS examination in the 15 detected prostatic cancers showed that 6(40%) were hypoechoic, 4 (26.7%) were of mixed hypo and hyper echogenicity, 1 (6.7%) was hyperechoic, and 4 (26.7%) were isoechoic. TRUS finding of a hypoechoic lesion was significantly associated with malignancy. Other TRUS findings such as texture, calcification, and cysts did not show any association with malignancy. Mortality was zero after ultrasound-guided prostate biopsy. TRUS is the diagnostic test of choice in detection of prostate cancer. With advances in the technique of TRUS, effort is being made to identify more subtle lesions in order to reduce random biopsies. 4-Dimensional TRUS does improve the diagnostic accuracy but there is still a group of patients with "invisible" cancers. Therefore, the policy of random biopsies has to be continued till this incidence can be eliminated.

Objective: To determine the detection rate and clinical pattern of prostate cancer in Kuwait. Subjects and Methods: One hundred and fifty-three males suspected of having prostate cancer based on elevation of prostate-specific antigen (PSA) of more than 4 ng/ml underwent transrectal-ultrasound (TRUS)-guided needle biopsy of the prostate between January 2003 and January 2008; these formed the study group. Analysis of prostate cancer was based on age, prostate volume, PSA level and on finding any abnormality based on a combination of the diagnostic tools. Results: A diagnosis of prostate cancer was histologically confirmed in 42 (27.4%) patients. In those aged <55, 56–65, 66–75 and >76 years, the detection rates were 16.7, 17.6, 33.3 and 40.7%, respectively. In those with prostate volumes of >71, 51–70, 31–50 and <30 g, the detection rates were 18.2, 23.8, 30.8 and 42.9%, respectively. When the PSA levels were divided into groups of 4–10, 10–20, 20–100 and >100 ng/ml, the cancer detection rate was 11.8, 20.5, 47.1 and 83.3%, respectively. When 1, 2 and 3 of the 3 diagnostic tools (digital rectal examination, PSA, TRUS) were abnormal, the detection rate was 15.6, 27.9 and 80%, respectively. Conclusions: Our data showed that the prostate cancer rate differs according to the region and that the rate was low in our center. Higher PSA and higher number of diagnostic tools with abnormal findings were associated with a higher incidence of prostate cancer.