This study was conducted to evaluate the etiological and clinical characteristics of urolithiasis in Iraqi children. From 1999 to 2004, 204 children with renal calculi were evaluated. The age range of the patients was 4 months to 14 years, 61.3% of the patients were under 5 years. Male to female ratio was 2.8:1. The mean age at onset of symptoms was 3.2 years, and stone disease was diagnosed at a mean of 3.5 years. Hematuria (44.6%) and pain (28.4%) were the main clinical presentation. Of the 204 patients 45.1% had a family history of stones. Consanguinity was recorded in 72%; 75.5% had metabolic disorders. Stones were located at multiple sites in 80 patients, or 39.2%; 58 of these 80, or 72.5%, had metabolic disorders. Multiple stones were present in 47 (23%); 72.3% were related to metabolic disorders. In 126 patients, or 61.8%, both kidneys were involved equally. Bladder stones were found in 11.3%. Staghorn calculi occurred in 29 patients, or 14.2%; 27 of these had recurrent urinary tract infection (UTI). Nephrocalcinosis was diagnosed in 7, or 3.4%; all had metabolic disorders. Etiology of stone formation was established in 189 patients, or 92.6%, whereas 15, or 7.4%, had idiopathic stones. Metabolic disorders were the commonest cause in 106 patients (52%); 52 patients were classified as infective (25.5%). Anatomical defects were present in 25 (12.2%) and 6 children (2.9%) with primary endemic bladder calculi. Coexisting UTI was common (36.8%) in the metabolic group. We concluded that urolithiasis is a serious problem among Iraqi children, with early onset of presentation. Metabolic disorders were the major causes, but can be masked by associated UTI. Proper management of UTI with a careful metabolic assessment of young stone formers is valuable in combating urolithiasis.

ObjectivesTo review the published cases of leiomyosarcoma of the urinary bladder and to report two further cases.MethodsThe databases Pubmed and Hinari were searched using the keywords ‘bladder’, ‘leiomyosarcoma’ and ‘smooth muscle neoplasm’. The 14 articles identified were reviewed, and we present a further two cases.ResultsOf more than 100 cases reported, 77 were reviewed. There is a lack of consensus about the standard treatment, and little is known about the natural history and prognosis of the tumour, due to its very low incidence. These tumours occur in older adults of either sex and are characterised by an aggressive behaviour. There is usually an unfavourable outcome, with the lungs being the most common site of metastasis. The two further cases we report had a different presentation and outcome.ConclusionsBecause of the limited experience with this rare tumour, there are insufficient data to suggest the optimum management strategy and prognosis.

Urothelial bladder tumour in childhood is extremely rare, and almost all the reported cases have been low-grade tumours with a favourable outcome. Here we review 57 reports comprising 127 cases, and we report two new cases.

BackgroundDifferent races have their own reference ranges of serum prostate-specific antigen (PSA) because of the influence of geographical and ethnic differences. In this study we determined the distribution of serum PSA levels in Iraqi men with no prostate cancer, to our knowledge the first such study from Iraq.Subjects and methodsFrom January 2003 to May 2004, in a prospectively designed study, we included 130 Iraqi men aged 20–79 years. The criteria of an elevated PSA level, abnormal ultrasonography results and/or abnormal findings on a digital rectal examination were used to exclude patients from the study. Ethnicity was not recorded, as Iraq has a multi-ethnic status. The results were analysed using descriptive statistics, statistical tables, the arithmetic mean, standard error, standard deviation, and by two extremes.ResultsThe PSA values in different age groups (20–29, 30–39, 40–49, 50–59 and 60–79) were, respectively, ⩾0.55 to ⩽1.3, ⩽1.6, ⩽2.0, ⩽4.6 and ⩽4.8 ng/mL. There was a significant increase between the third and fourth group, and all these results were significant at P < 0.001, with the last being more significant.ConclusionSerum PSA measurements should be standardized according to country and ethnic groups. Our result of a PSA maximum at 4.8 ng/mL is slightly more than the international standard threshold of 4.0 ng/mL.

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