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Article
Inconclusive Urinary Bladder Biopsy; Facts and Lessons

Author: Ausama Saadi Abdul Muhsin
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 4 Pages: 303-306
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:To review the pathologic analysis of urinary bladder biopsies and study the frequency and causes of inconclusive biopsies among Iraqi patients.METHODS:This is a retrospective study in which 933 patients underwent 1047 urinary bladder biopsy procedures during endoscopic evaluation, or transurethral resection of a known bladder cancer in Surgical Specialties Hospital, Baghdad, Iraq between June 2000 and June 2007. Pathologic records of patients were reviewed.RESULTS:In 933 patients aged 2-100 years with a mean age of 56.87±14.3 years who underwent 1047 urinary bladder biopsy procedures, pathologic review showed bladder cancer in 655 (62.56%) biopsies, no overt malignancy in 340 (32.47%) biopsies, no pathological diagnosis could be made in 43 (4.11%) biopsies, and normal biopsy in 9 (0.86%) biopsies. In 238 bladder cancer biopsies, pathologic analysis of muscle invasion was not carried out due to their lack of muscular tissue.CONCLUSION:Urinary bladder biopsy is one of the most common biopsies in urology practice. Every effort is made to prevent technical defects of taking and processing such biopsies, to optimize pathologic analysis and surgical management.

Keywords

Bladder biopsy --- Cystoscopy


Article
Schistosoma – Associated Bladder Cancer in Iraq Single Center Pathologic Review

Author: Ausama Saadi Abdul Muhsin
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 2 Pages: 174-177
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:OBJECTIVE:To study the frequency of schistosomiasis in pathologic urinary bladder specimens and the contribution of transitional cell and squamous cell types to the schistosoma – associated and non schistosoma – associated bladder cancer among Iraqi patients.METHODS:This is a retrospective study in which 1092 pathologic records of 933 patients, who underwent urinary bladder biopsies from bladder tumors or suspicious lesions discovered incidentally during endoscopic evaluation and those who ultimately had radical cystectomy and urinary diversion for invasive bladder cancer, were reviewed in Surgical Specialties Hospital, Baghdad, Iraq between June 2000 and June 2007.RESULTS:In this study 933 patients aged 2-100 years with a mean age of 56.87±14.3 years. Pathologic review showed schistosomiasis in 81 (8.68%) patients of whom schistosoma associated bladder cancer was reported in 49 (60.5%) patients and schistosomiasis with no pathologic evidence of malignancy in 32 (39.5%) patients. The cell type of schistosoma associated bladder cancer was transitional cell carcinoma (TCC) in 26 (53%), squamous cell carcinoma (SCC) in 19 (38.7%), adenocarcinoma in 1 (2%), and undifferentiated in 3 (6.12%) patients. Out of 852 patients with no pathologic evidence of schistosomiasis, 563 were reported to have non schistosoma associated bladder cancer. The cancer cell type was TCC in 491 (87.21%), SCC in 45 (7.99%), adenocarcinoma in 15 (2.66%), undifferentiated in 11 (1.95%) and sarcoma in 1 (0.18%) patients.CONCLUSION:Schistosoma associated bladder cancer is still a problem in Iraq as well as other endemic countries. Although the major histological cell type of such cancer in Iraq was SCC, there is a trend for increasing frequency of TCC among patients infected with schistosomiasis.


Article
Urethral Strictures Associated with the Management of Non Muscle Invasive Bladder Carcinoma

Authors: Reyad Ahmed Farhood --- Issam Salman AL-Azzawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 1 Pages: 18-23
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Carcinoma of Bladder is a common urological tumor. Urethral strictures with different grades are frequently seen in patients with non muscle invasive bladder cancer .OBJECTIVE:To elicit the incidence of urethral strictures, their severity and correlation with different factors in patients managed for non muscle invasive bladder tumor.PATIENTS AND METHODS:In a prospective study from January 2008 to January 2010 ,we followed 98 patients with superficial bladder tumor ,they were all male their age ranged from 38-76 years, all patients diagnosed endoscopically and histologically staged as superficial bladder tumor (excluding invasive bladder tumor),we follow those patients with a history regarding any change in urinary stream then urethrocystoscopically during a period of 1-2 years, we classify urethral strictures that was urethroscopically diagnosed as mild, moderate and sever.For each urethral stricture case we state the site and severity of the stricture, the number of preceding cystoscopies, duration of TURBT procedure and number of preceding chemotherapy sessions , the type of chemotherapy used and method of treatment required in each case.RESULTS:During the period of the study , a total of 23 urethral strictures (23.5%) were identified. They were all in the bulbar urethra, they were mild in 10 patients (43.5%), Moderate in 6 patients (26.1%) and sever in 7 patients (30.4%) and 14 patients with urethral stricture had also B.P.H(60.9%).Prior to the occurrence of stricture; urethrocystocopy was done once in 55.5% of cases , twice in 26.1% and 3 or more in 17.4%.Duration of TURBT procedure was≤20 mints in 30.4% and > 20 mints in 69.6%.Intravesical chemotherapy sessions were 0-3 in 17.4% of patients, 6 in 43.5% and more than 6 in 39.1%.The type of chemotherapeutic agent used was Doxorubicin in 56.5% of patients Mitomycin-c- in 26.1% and both of them (through multiple courses) in 13%.CONCLUSION:Urethral stricture associated with the management of non muscle invasive bladder tumors is a common and important clinical problem that need to be considered and avoided as far as possible ,Factors that may had a positive impact on the incidence of stricture were : B.P.H , duration of TURBT procedure, the number of intravesical chemotherapy sessions(6 and more) and doxorubicin instillation.


Article
Cystoscopic anystoscopic an ystoscopic an ystoscopic an d Histopathologic istopathologic istopathologic istopathologic istopathologic Patternsatterns atterns in in Iraqi raqi Patients atients atients with with Chronic hronic hronic Cystitis /ystitis /ystitis / ystitis / Painful ainful Bladder ladder ladder ladder Syndromeyndrome yndromeyndromeyndrome

Authors: Mohammad Jabar AL-Robaiee --- Issam Salman AL-Azzawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 209-213
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Chronic cystitis symptoms with negative cultures always represent achallenge to the urologist because of the uncertainty in etiology and heterogenous pathological findings.OBJECTIVE:To elecit the role of cystoscopy and biopsy in disclosing the different pathological patterns in our patients with chronic cystitis like syndrome and to compare them with the pathological patterns of western patients.PATIENTS AND METHODES:This study included 64 patients (40 males and 24 females) with a persistent symptom complex of supra pubic pain, dysuria,frequency and urgency (cystitis –like syndrome)for 12 months and above , in the absence of neurological and gynaeco logical findings or positive cultures.The mean patient age was 38 years (20-68ys).The mean duration of symptoms was 26 months .All patients were subjected to a full urological evaluation, cystoscopy under G/A with hydro distension , biopsy and histopathologic examination .RESULTS:The commonest cystoscopic findings were dilated vessels, sub mucosal petechial haemorrhage after hydro distension , bilharzial lesions, mucosal cracks and small polypoid masses.Histopathologic examination revealed variable lesions as chr. Inflammatory cell infiltration, Brunns nests, cystitis cystica, metaplasia , Bilharzial reaction and ova and in situ carcinoma.Most patients had more than one lesion , especially sub mucosal petechial haemorrhage associated with bilharzial lesions or in situ carcinoma.CONCLUSION:In our patients, the chronic abacterial cystitis syndrome is common in both males and females and has different pathological findings.It is therefore , different from the pattern of the syndrome found in western patients where it mainly affects females and most often in the form of interstitial cystitis .This may be attributed to the high prevalence of stone disease and bilharziasis in addition to the highly concentrated urine of our patients.We, thus , consider it mandatory to do cystoscopy and bladder biopsy for every patient presenting with chronic cystitis like symptoms


Article
Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors

Author: Jassim Mohammad Alkhazraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 4 Pages: 536-541
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladderurothelium other than the principal lesions can provide distinct diagnostic information with regard totreatment response and outcome. Positive mucosal biopsy results are a significant indicator ofintravesical recurrence. Currently, in our urological practice, the importance of performing this step incystoscopy is relatively underestimated.OBJECTIVE:The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa fordysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopicappearance of the tumor.MATERIALS AND METHODS:A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, eitherby cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa ofthe bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examinedby the same histopathologist. All patients were managed according to their presentation, cystoscopicand histopathological findings.RESULTS:Statistical analysis showed that the highest significant difference was obtained in patients with tumorgrade, low against high grade (p<0.005). However, a noticeable difference was found in the other twocomparison groups, namely, the type, transitional against squamous and the macroscopic appearance,papillary against solid (p<0.05).CONCLUSION:The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosaldysplastic changes which may exclude the bladder preserving procedures as an option of surgicaltreatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for abetter treatment and outcome of bladder carcinoma which is a major health problem


Article
Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors

Author: Jassim Mohammad Alkhazraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 4 Pages: 536-541
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladderurothelium other than the principal lesions can provide distinct diagnostic information with regard totreatment response and outcome. Positive mucosal biopsy results are a significant indicator ofintravesical recurrence. Currently, in our urological practice, the importance of performing this step incystoscopy is relatively underestimated.OBJECTIVE:The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa fordysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopicappearance of the tumor.MATERIALS AND METHODS:A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, eitherby cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa ofthe bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examinedby the same histopathologist. All patients were managed according to their presentation, cystoscopicand histopathological findings.RESULTS:Statistical analysis showed that the highest significant difference was obtained in patients with tumorgrade, low against high grade (p<0.005). However, a noticeable difference was found in the other twocomparison groups, namely, the type, transitional against squamous and the macroscopic appearance,papillary against solid (p<0.05).CONCLUSION:The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosaldysplastic changes which may exclude the bladder preserving procedures as an option of surgicaltreatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for abetter treatment and outcome of bladder carcinoma which is a major health problem.

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