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Almuhanna AM, Alsuhaibani S, Almesned R, Almatar A, Alali H. Zinner's syndrome: Case report of a rare maldevelopment in the male genitourinary tract. Urol Case Rep 2021; 39:101839. [PMID: 34584848 PMCID: PMC8455976 DOI: 10.1016/j.eucr.2021.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
Zinner syndrome is a rare congenital malformation of the urogenital tract. It is due anomaly in the developmental of Wolffian duct. Zinner syndrome comprises triad of seminal vesicle cyst, unilateral renal agenesis and ipsilateral ejaculatory duct obstruction. It is frequently associated with infertility. Herein we are highlighting a case of a 35 years-old male, a father of 4 biological children who presented to our clinic due to right hemiscrotal pain, associated with post ejaculation pain.
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Affiliation(s)
- Ahmed M. Almuhanna
- Urology Department, King Fahad Hospital, Al-Ahsa, Saudi Arabia
- Corresponding author.
| | - Shaheed Alsuhaibani
- U rology Department, King Fahad Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Razan Almesned
- Urology Department, King Faisal Specials Hospital, Riyadh, Saudi Arabia
| | - Ashraf Almatar
- Urology Department, King Fahad Specials Hospital, Dammam, Saudi Arabia
| | - Hamed Alali
- Urology Department, King Fahad Specials Hospital, Dammam, Saudi Arabia
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Alshamsi H, Sarhan OM, Almatar A, Ali BA, Boqari D, Kawai FA. Unusual Presentation, Relapse, and Metastasis of a Pediatric Testicular Yolk Sac Tumor: Case Report. Urology 2020; 149:e40-e43. [PMID: 33141029 DOI: 10.1016/j.urology.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Testicular tumors are not uncommon in children and represent 1%-2% of all pediatric malignancies. Prepubertal testicular yolk sac tumor is the most common childhood testicular cancer, accounting for 70%-80% of all cases. The clinical presentation varies from one patient to another; most common presentation is painless scrotal mass. Herein, we present a case of pediatric patient with a testicular yolk sac tumor who had unusual presentation followed by a local relapse and metastasis and continued to have high markers while he was on chemotherapy, then underwent retroperitoneal lymph node dissection and local recurrence excision.
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Affiliation(s)
- Hend Alshamsi
- Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Osama M Sarhan
- Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Ashraf Almatar
- Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Batool Al Ali
- Pathology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Deena Boqari
- Pathology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Fouad Al Kawai
- Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Gillis CJ, Rendon R, MacDonald LP, Jewett MA, French C, Ajzenberg H, Almatar A, Abdolell M, Organ M. Identification of tumor size as the only factor associated with nondiagnostic biopsies in patients with small renal masses. Can Urol Assoc J 2020; 14:E220-E223. [PMID: 31793862 PMCID: PMC7197968 DOI: 10.5489/cuaj.6103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION As greater numbers of small renal masses (SRMs) are discovered incidentally, renal tumor biopsy (RTB) is an increasingly recognized step for the management of these lesions, ideally for the prevention of surgical overtreatment for benign disease. While the diagnosis can often be obtained preoperatively by RTB, indeterminate results create greater difficulty for patients and clinicians. This study examines a series of RTBs, identifying the portion of these that were able to yield a diagnosis, and correlates patient factors, including RENAL and PADUA scoring, with the outcome of a non-diagnostic result. METHODS Patients were identified as having undergone RTB at the Princess Margaret Cancer Centre in Ontario, Canada, between January 2000 and December 2009. Data was compiled from these 423 patients and analyzed using CART methodology to determine the level of association between various patient and tumor factors and the outcome of a non-diagnostic biopsy. Tumor size was further used to develop a classification tree to describe the prediction of a non-diagnostic biopsy. RESULTS Of these 423 patients undergoing RTB, 66 (16%) resulted in a non-diagnostic biopsy. The only patient or tumor factor that was found to be associated with a non-diagnostic outcome was mass size, where small masses (<1.28 cm diameter) were found to have a 38% chance of being non-diagnostic, compared with a 13% chance in those tumors >1.28 cm diameter (86% accuracy, 95% confidence interval [CI] 0.82-0.89). CONCLUSIONS When evaluating SRMs for diagnostic workup, mass size is the only tumor or patient characteristic associated with a non-diagnostic RTB.
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Affiliation(s)
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Michael A.S. Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | | | | | - Ashraf Almatar
- Department of Urology, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Mohammed Abdolell
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Michael Organ
- Department of Urology, Memorial University, St. John’s, NL, Canada
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Organ M, MacDonald LP, Jewett MAS, Ajzenberg H, Almatar A, Abdolell M, Acker MR, Rendon R. Classification tree for the prediction of malignant disease and the prediction of non-diagnostic biopsies in patients with small renal masses. Can Urol Assoc J 2018; 13:115-119. [PMID: 30059288 DOI: 10.5489/cuaj.5196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Preoperative prediction of benign vs. malignant small renal masses (SRMs) remains a challenge. This study: 1) validates our previously published classification tree (CT) with an external cohort; 2) creates a new CT with the combined cohort; and 3) evaluates the RENAL and PADUA scoring systems for prediction of malignancy. METHODS This study includes a total of 818 patients with renal masses; 395 underwent surgical resection and 423 underwent biopsy. A CT to predict benign disease was developed using patient and tumour characteristics from the 709 eligible participants. Our CT is based on four parameters: tumour volume, symptoms, gender, and symptomatology. CART modelling was also used to determine if RENAL and PADUA scoring could predict malignancy. RESULTS When externally validated with the surgical cohort, the predictive accuracy of the old CT dropped. However, by combining the cohorts and creating a new CT, the predictive accuracy increased from 74% to 87% (95% confidence interval 0.84-0.89). RENAL and PADUA score alone were not predictive of malignancy. One limitation was the lack of available histological data from the biopsy series. CONCLUSIONS The validated old CT and new combined-cohort CT have a predictive value greater than currently published nomograms and single-biopsy cohorts. Overall, RENAL and PADUA scores were not able to predict malignancy.
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Affiliation(s)
- Michael Organ
- Department of Urology, Memorial University, St. John's, NL, Canada
| | | | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Henry Ajzenberg
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Ashraf Almatar
- Department of Urology, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Mohamed Abdolell
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Matthew R Acker
- Department of Urology, Dalhousie University, Saint John, NB, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Almatar A, Wallis CJD, Herschorn S, Saskin R, Kulkarni GS, Kodama RT, Nam RK. Effect of radical prostatectomy surgeon volume on complication rates from a large population-based cohort. Can Urol Assoc J 2016; 10:45-9. [PMID: 26977206 DOI: 10.5489/cuaj.3214] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Surgical volume can affect several outcomes following radical prostatectomy (RP). We examined if surgical volume was associated with novel categories of treatment-related complications following RP. METHODS We examined a population-based cohort of men treated with RP in Ontario, Canada between 2002 and 2009. We used Cox proportional hazard modeling to examine the effect of physician, hospital and patient demographic factors on rates of treatment-related hospital admissions, urologic procedures, and open surgeries. RESULTS Over the study interval, 15 870 men were treated with RP. A total of 196 surgeons performed a median of 15 cases per year (range: 1-131). Patients treated by surgeons in the highest quartile of annual case volume (>39/year) had a lower risk of hospital admission (hazard ratio [HR]=0.54, 95% CI 0.47-0.61) and urologic procedures (HR=0.69, 95% CI 0.64-0.75), but not open surgeries (HR=0.83, 95% CI 0.47-1.45) than patients treated by surgeons in the lowest quartile (<15/year). Treatment at an academic hospital was associated with a decreased risk of hospitalization (HR=0.75, 95% CI 0.67-0.83), but not of urologic procedures (HR=0.94, 95% CI 0.88-1.01) or open surgeries (HR=0.87, 95% CI 0.54-1.39). There was no significant trend in any of the outcomes by population density. CONCLUSIONS The annual case volume of the treating surgeon significantly affects a patient's risk of requiring hospitalization or urologic procedures (excluding open surgeries) to manage treatment-related complications.
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Affiliation(s)
- Ashraf Almatar
- Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, ON, Canada
| | - Refik Saskin
- Institute of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, University Health Network, University of Toronto, ON, Canada
| | - Ronald T Kodama
- Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, ON, Canada
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Ahmadi H, Jewett MAS, Shore ND, Alkazaz N, Almatar A, Latini DM, Legere L, Messing E, Thrasher JB, Lee CT. The Need for Survivorship Care in Genitourinary Cancers: Considerations from SUO and LUGPA. Urol Pract 2016; 3:62-69. [PMID: 37592469 DOI: 10.1016/j.urpr.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A quarter of American cancer survivors have genitourinary malignancies that are largely managed by urologists. We explored urologist perceptions about survivorship care for genitourinary malignancies. METHODS A total of 701 SUO (Society of Urologic Oncology) and 1,746 LUGPA (Large Urology Group Practice Association) members were invited to complete a web based survey composed of 5 domains, including 1) demographics, 2) current survivorship care practices, 3) perceived barriers, 4) accessibility to survivorship resources and 5) perceptions of advocacy groups. RESULTS Of 191 respondents 137 (72%) had no training in survivorship care. Of the 174 respondents 129 (74%) practiced shared care models while 45 (26%) preferred pure specialized followup care. Only 39 of 129 respondents (30%) with a shared care model always provided a written care plan. These plans infrequently included information on lifestyle modifications and educational resources. Routine patient referral to advocacy organizations was highest for prostate cancer at 40% followed by bladder, testicular and kidney cancers at 17%, 10% and 8%, respectively. Lack of time/resources and practice guidelines were considered the 2 most important barriers to survivorship care by 31% and 30% of participants, respectively. Web based information on advocacy groups and best practice guidelines were selected as the most important initiatives to promote survivorship care. CONCLUSIONS Despite the low response rate this study highlights important practice gaps in survivorship care for patients with genitourinary malignancies. In collaboration with advocacy organizations professional societies should initiate programs to better educate and train their members in survivorship care guidelines and consensus best practices.
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Affiliation(s)
- Hamed Ahmadi
- Oregon Health and Science University, Portland, Oregon
| | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina
| | - Nour Alkazaz
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Laura Legere
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ed Messing
- University of Rochester School of Medicine and Dentistry, Rochester, New York
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Almatar A, Richter S, Lalani N, Bender JL, Wiljer D, Alkazaz N, Legere L, Maganti M, Sridhar SS, Catton PP, Jewett MAS. Practice patterns and perceptions of survivorship care in Canadian genitourinary oncology: A multidisciplinary perspective. Can Urol Assoc J 2015; 8:409-17. [PMID: 25553154 DOI: 10.5489/cuaj.2279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is little knowledge of survivorship care specific to genitourinary (GU) cancers. To improve care delivery to this patient population, we need to clearly define physician perceptions of survivorship care. We therefore conducted a study to determine the challenges to GU cancer survivorship care in Canada. METHODS A web-based questionnaire was e-mailed to physicians treating GU cancers in Canada, including urologists, radiation oncologists, and medical oncologists. Five domains were assessed: demography, current post-cancer treatment care, perspectives on barriers to survivorship care, accessibility to survivorship resources, and perspectives about advocacy groups. RESULTS There were 306 responses, with 260 eligible for study. A total of 82% of physicians involve primary care practitioners (PCPs) at some point in survivorship care. Most physicians provide some form of written follow-up plan to PCPs. However, only 25% provided lifestyle recommendations and 53% included persistent and late effects of therapy. Lack of time or resources dedicated to survivorship care was the most commonly reported barrier. There was variation in accessibility to survivorship support programs among different subspecialties and regions. Advocacy groups generally were underutilized, particularly in testis cancer. Low response rate and the potential response bias are the main limitations of this survey. CONCLUSION To our knowledge this is the first study to address the challenges of GU cancer survivorship care in Canada. The barriers and accessibility of survivorship care quoted in this survey may be used to improve care for this group of patients. Underutilization of advocacy groups may stimulate the advocacy groups and institutions to address its causes and solutions.
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Affiliation(s)
- Ashraf Almatar
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Suzanne Richter
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Nafisha Lalani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Jackie L Bender
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON
| | - David Wiljer
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON
| | - Nour Alkazaz
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON
| | - Laura Legere
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Srikala S Sridhar
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Pamela P Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON; ; ELLICSR: Health, Wellness and Cancer Survivorship Centre, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
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Kurban G, Gedye C, Morales C, Yousef GM, Almatar A, Jewett MAS. Diagnosis and treatment of small renal masses: the role for molecular biology. ARCH ESP UROL 2013; 66:505-516. [PMID: 23793768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Renal cell carcinoma (RCC), the most common type of kidney cancer, is increasing in incidence and is the most lethal genitourinary cancer. Due to the increasing use of abdominal imaging, incidentally detected, asymptomatic small renal masses (SRMs), most of which are RCC, have become the most common presentation of kidney cancer. Most RCC SRMs initially grow slowly or not at all, but others progress to advanced and metastatic cancer. Several diagnostic and prognostic genomic, transcriptomic and proteomic studies have been completed in RCC, however signatures for SRM progression have not been identified. In the absence of useful factors to distinguish those tumors requiring treatment for progression from those that can be managed by active surveillance alone, most SRMs are treated as RCC with surgery. Currently, the only prognostic factor at diagnosis is tumor size. Tumor growth rate also appears to identify potential progressive tumours. Identifying signatures for progression and the utilization of needle biopsies will be important for SRM patients and will guide therapy.
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Affiliation(s)
- Ghada Kurban
- Ontario Cancer Institute, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Organ M, Jewett M, Almatar A, Ajzenberg H, Abdolell M, Rendon R. 1455 UTILITY OF R.E.N.A.L. NEPHROMETRY AND PADUA SCORING FOR THE PREDICTION OF BENIGN VERSUS MALIGNANT DISEASE IN PATIENTS WITH SMALL RENAL MASSES. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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