This scoring system can potentially diagnose or rule out testicular torsion in 80% of cases, with high positive and negative predictive values for selected cutoffs. Ultrasound orders would be decreased to 20% of acute scrotum cases. Prospective validation of this scoring system is necessary.
Parents and patients prefer robot-assisted laparoscopic surgical scars to open surgical scars for pediatric ureteral reimplantation, pyeloplasty and bladder augmentation. Scar appearance is an important influence on the decisions of parents and patients, and should be discussed when surgical treatment is presented.
ObjectiveTo evaluate the clinical and pathological factors influencing the risk of disease progression in a cohort of patients with low-intermediate risk prostate cancer under active surveillance (AS).
Patients and MethodsWe studied 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favourable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least one repeat biopsy and no progression criteria at the time of the diagnosis were included for statistical analyses. Patients were followed every 3-6 months for prostate-specific antigen (PSA) measurement and physical examination. Patients were offered repeat prostatic biopsy every year. Disease progression was defined as the presence of one or more of the following criteria: ≥3 positive cores, >50% of cancer in at least one core, and a predominant Gleason pattern of 4.
ResultsFor the 155 patients, the mean (SD) age at diagnosis was 67 (7) years; the median (interquartile range) follow-up was 5.4 (3.6-9.5) years. Of these, 67, 25, six, and two patients had two, three, four, and five repeat biopsies, respectively. At baseline, 11 (7%) patients had a Gleason score of 3+4, while the remaining 144 (93%) patients had a Gleason score of ≤6. In all, 50 (32.3%) patients had disease progression on repeat biopsies, with a median progression-free survival time of 7 years. The rate of disease progression decreased after the second repeat biopsy. The 5-year overall survival rate was 100%. Having a PSA density (PSAD) of >0.15 ng/mL/mL, >1 positive core, and Gleason score >6 at the time of the diagnosis was associated with a significantly higher rate of disease progression on univariate analysis (P < 0.05), while a maximum percentage of cancer in any core of >10% showed a trend toward significance for a higher progression rate (P = 0.054). On multivariate analysis, only the presence of a PSAD of >0.15 ng/mL/mL remained significant for a higher progression rate (P < 0.05). Of the 155 patients, five (3.2%) subsequently received radiotherapy, 13 (8.4%) received hormonal therapy, and 13 (8.4%) underwent radical prostatectomy.
ConclusionAS is a suitable management option for patients with clinically low-risk prostate cancer. A PSAD of >0.15 ng/mL/mL is an important predictor for disease progression.
The majority of our patients did not develop UDF while under AS. Our study, thus, suggests that careful patient selection for focal therapy should be performed to avoid subjecting patients to unnecessary treatment.
Introduction:The knowledge of the general population about the medical specialties is not well studied in our community. Our aim is to explore the amount of knowledge known about urology by the general population.Materials and Methods:A questionnaire was completed by 154 respondents in Jeddah, Saudi Arabia. After measuring the amount of knowledge in our population, we looked forward to compare it with English as well as French speaking population in North America (NA). We translated to Arabic the same questionnaire used in their study. Two extra questions were added to further serve our aim.Results:Of the 154 respondents, 66% (102) said that they know little or nothing about urology, and 43% (66) did not know that urology involves surgery. When asked to mention three diseases within the field of urology, only 37% (57) were able to do so. Fourteen percent (21) were unable to mention even one disease. When asked about naming modalities of treatment in urology, 67% (104) were able to mention one or more. The rest were unable to mention even one modality. Most of the wrong answers were related to mixing urology with anatomically related fields rather than pronunciation similarity. Most of the results were better when compared to the studies done in NA.Conclusion:Although significant proportion of our population know little about the field of urology, the overall result is better when compared to North American population. The clarity of Arabic terminology related to the field may explain the difference.
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