Can We Predict the Grade of Clear Cell Renal Cell Carcinoma from Houns-Field Unit of Renal Lesion on Computerized Tomography Scan, a Retrospective Cross-Sectional Study

Mohammad Al-Zubi,1 Khayry Al-Shami,2 Leen Sawalha,3 Heyam Mahmoud Alguzo,2 Saddam Al Demour,4 Asma’a Mohammad Al-Mnayyis,2 Rami Alazab,5 Samer Fathi Al-Rawashdah,6 Lana Talal Alzoubi,7 Sawsan Radi Al-khawaldeh2 1Department of Surgery, Division of Urology, Yarmouk University MEdical SChool, Irbid, 21110, Jodan; 2Department of Clinical Medical Sciences, Yarmouk University Medical school, Irbid, Jordan; 3Department of Clinical Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Special Surgery, Division of Urology, the University of Jordan medical School, Amman, 11972, Jordan; 5Department of Surgery & Urology, Jordan University of Science & Technology, Irbid, 21110, Jordan; 6Department of Special Surgery, School of Medicine, Mutah University medical School, Karak, 61710, Jordan; 7Department of Dentistry, Private Sector, Amman, JordanCorrespondence: Mohammad Al-Zubi, Tel +962 789724264, Email [email protected]: Renal cell carcinoma (RCC) is a type of urological malignancy that affects approximately 2% of the global population. Imaging modalities, especially computed tomography (CT) scanning, play a critical role in diagnosing RCC. In this study, we investigated whether there is a relationship between tumour grade of clear cell RCC and HU values of renal lesions on CT scan performed before operation.Materials and Methods: We conducted a retrospective analysis of 123 patients who underwent radical or partial (open or laparoscopic) nephrectomy for clear cell RCC between January 2017 and January 2021. Post-operation histopathological grades were recorded according to World Health Organization (WHO)/International Society of Urological Pathology (ISUP) 2016 grading system and divided into low grade (includes grade 1 and 2) and high grade (grade 3 and 4), and their links to age, sex, smoking habits, tumour size, and HUs of renal lesions were evaluated.Results: The mean age of the patients studied was 63.02 years old. About 56.9% of the patients were low grade (grade 1 or grade 2), while 43.1% were high grade (grade 3 or 4). The mean tumour size was 6.31 cm. There were no significant differences in tumour grade according to age, sex, or smoking habits. We found a significant relation between tumour grade and HU in the pre-contrast and nephrogenic phases, with p values of 0.001 and 0.037, respectively. On the other hand, there was no significant relation linking the tumour grade to the difference in HU between these phases, where there was a p value of 0.641.Conclusion: HU in the pre-contrast and nephrogenic phases in addition to tumour size on CT scan have a significant relation to clear cell RCC grade.Keywords: renal cell carcinoma, grade, stage, Hounsfield unit, CT sca

Approach to Adult Patients with Musculoskeletal Complaints and Normal Findings: A Guide for Clinical Practice

Moh’d S Dawod,1 Mohammad N Alswerki,2 Ahmad F Alelaumi,2 Saif A Alshloul,3 Malik Y Husami,3 Salsabil G Sulaiman,3 Maryam T Al-Azzawi,3 Samer Fathi Al-Rawashdah,4 Saleh Abualhaj5 1Department of Orthopedic Surgery, Faculty of Medicine, Mutah University, Al-Karak, Jordan; 2Department of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan; 3Department of Surgery, Jordan University Hospital, Amman, Jordan; 4Department of Urology Surgery, Faculty of Medicine, Mutah University, Al-Karak, Jordan; 5Faculty of Medicine, Al-Balqa Applied University, Al-Salt, JordanCorrespondence: Mohammad N Alswerki, Orthopedic Department, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan, Email [email protected]: Musculoskeletal (MSK) complaints are among the most common reasons for visits to primary care and outpatient clinics. While many cases are attributed to identifiable pathology, a significant proportion of patients present with persistent MSK symptoms despite normal physical examinations and imaging findings. These presentations pose diagnostic and management challenges and often result in patient frustration, clinician uncertainty, and overutilization of healthcare resources.Objective: This narrative review aims to provide a comprehensive, evidence-informed, and practical framework for clinicians to evaluate and manage patients with MSK complaints in the absence of clear diagnostic abnormalities.Methods: A targeted narrative review was performed using PubMed, MEDLINE, and major international clinical guidelines to identify relevant literature on the evaluation and management of musculoskeletal (MSK) pain without objective abnormalities. Evidence and expert consensus were synthesized into a biopsychosocial diagnostic and management framework specifically tailored for primary care and general outpatient settings.Key Findings: The review underscores the importance of empathetic communication, structured clinical assessment, and early exclusion of serious pathology. It presents a broad differential diagnosis encompassing mechanical, neuropathic, nociplastic, referred, and functional pain mechanisms. Management strategies are organized across key domains, including watchful follow-up, patient education, graded physical activity, stress and lifestyle management, psychosocial and occupational support, and functional goal setting. Pharmacologic therapy—such as short-term use of paracetamol or NSAIDs, and selected antidepressants for chronic nociplastic pain—should be considered cautiously and within a multidisciplinary, shared-decision framework. Opioid use is discouraged due to limited efficacy and high potential for harm.Conclusion: Patients presenting with MSK complaints and normal diagnostic findings benefit most from a structured, individualized, and patient-centered approach that integrates clinical reasoning, effective communication, and functional rehabilitation. Applying this framework enables clinicians to address the multidimensional nature of such presentations while avoiding unnecessary investigations or interventions.Keywords: musculoskeletal pain, normal imaging, diagnostic uncertainty, biopsychosocial model, patient-centered care, non-specific pain, primary care managemen

Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic and care pathway

Introduction: Benign prostatic hyperplasia (BPH) resulting in lower urinary tract symptoms (LUTS) is a widespread disease that strongly interferes with the quality of life (QoL) of elderly males. It represents a real clinical and socio-economic problem may be due to the lack of a diagnostic, therapeutic and care pathway (DTCP) tool for LUTS/BPH that considers elderly people population in its whole complexity. The aim of this study was to evaluate the clinical effectiveness of the proposed DTCP LUTS/BPH tool. Methods: This prospective study was conducted on 278 patients over 75 years old with non-neurogenic LUTS recruited from February to July 2014 by 10 general practitioners (GP) and two assisted sanitary residences (ASR). Only five GPs and one ASR were provided with the complete DTCP LUTS/BPH tool to create two different groups of patients: group A (138 patients) was treated without the aid of the DTCP; group B (140 patients) was treated according to the DTCP. Results: At 1 year of follow-up, the patients of Group B compared with Group A achieved a greater and significant mean reduction in the questionnaires score (International Prostate Symptom Score, Quick prostate test and QoL) linked to a higher increase in the flowmetry parameters (Qmax) and a lower postvoid residual. Furthermore, in Group B compared to Group A, a greater improvement of hydronephrosis, creatinine values and erectile dysfunction (ED) were obtained at 1 year of follow-up. Conclusion: The encouraging results obtained from this study are significant and support the use of this diagnostic, therapeutic and care tool (DTCP) as the ideal pathway management for elderly men with LUTS associated to BPH and ED. Further studies with greater number of elderly subjects and long-term follow-up are needed to confirm DTCP utility in the clinical management of LUTS/BPH and ED

Does post-void residual urine volume affect potential recurrence risk for non-muscle invasive bladder cancer?

Plain language summaryAim: Bladder cancer is the second most common urological malignancy after prostate cancer. Increase in the post-void residual (PVR) volume may result in an increase in the risk of cancer recurrence. Methods: Patient demographic data, tumor stage and grade, PVR volume and 2 years follow-up data for recurrence were obtained. Results: The increase of PVR volume was related to short recurrence-free survival (RFS) especially for patients with PVR volume of 60 ml or more. Conclusion: Low PVR volume in patients with non-muscle invasive bladder cancer may play a role in reducing cancer recurrence. However further research is needed in this field.Aim: Bladder cancer is the second most common urological malignancy after prostate cancer. Increase in the post-void residual (PVR) volume may result in an increase in the risk of cancer recurrence. Methods: Patient demographic data, tumor stage and grade, PVR volume and 2 years follow-up data for recurrence were obtained and evaluated. Results: One-hundred-and-nineteen patients were subdivided into three groups according to PVR urine volume. The increase of PVR volume was related to short recurrence-free survival (RFS) especially for patients with PVR volume of 60 ml or more. Conclusion: Low PVR volume in patients with non-muscle invasive bladder cancer may play a role in reducing cancer recurrence. However further research is needed in this field

Pure intracorporeal laparoscopic radical cystectomy with orthotopic "U" shaped ileal neobladder.

BACKGROUND: Radical cystectomy with pelvic lymph node dissection represents the standard treatment for muscle-invasive, and high-risk non-muscle-invasive bladder cancers. Aim of this study was to report our case series of 30 patients undergoing totally laparoscopic radical cystectomy (LRC) with reconstruction of an intracorporeal orthotopic ileal neobladder. Intra- and perioperative results and the functional and oncological outcomes 9 months after operation are reported. METHODS: Between October 2010 and December 2012, 30 male patients underwent LRC with a pure laparoscopic orthotopic ileal “U”- shaped neobladder diversion. The men had a median age of 67 years, a median body mass index of 22.3, and a mean ASA score of 2.2; they represented various clinical stages of disease. RESULTS: None of the patients required conversion to open surgery, and no perioperative mortalities were reported. The median operating time was 365 min, and the median blood loss was 290 mL, with a transfusion rate of 26.6%. All surgical margins were negative; 8 patients with non–organ-confined disease or positive lymph nodes received adjuvant chemotherapy. Early complications (within 30 days) occurred in 7 patients, and late complications occurred in 6 patients. The mean hospital stay was 9 days. At 9 months after surgery, the daytime continence rate was 83.3% and the nighttime continence rate was 73.3%. CONCLUSIONS: Pure LRC with intracorporeal orthotopic ileal neobladder reconstruction may represent a viable alternative to open radical cystectomy, with a significant reduction in patient morbidity. Future, large, randomized controlled trials with extensive follow-up are needed to confirm our encouraging results