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Background: One of the leading causes of mortality and morbidity worldwide is cancer; this encompasses a challenging health issue for both health providers and the community. Bladder cancer is the ninth most common cancer worldwide. However, few studies have been conducted to estimate the level of knowledge and awareness of urinary bladder cancer among the general population globally and nationally. Therefore, the following study aims to assess the magnitude and level of awareness of urinary bladder cancer among citizens in western Saudi Arabia. Methodology: The following survey-based cross-sectional study was conducted in Saudi Arabia's western region from April to May 2019. A structured questionnaire exploring the knowledge of urinary bladder cancer was given to the participants. In addition, participants' demographics, social determinants, and past personal and family histories were gathered. The sum of the awareness responses was graded as positive or negative and correlated to determinants. Results: A total of 927 participants participated in the study. 74.2% were male, and for most participants, the highest educational level was a university degree (64.7%). The majority of the participants were unmarried (single) (51%) and widowed participants represented the lowest response (3.7%). The majority of the participants were aware of the term "urinary bladder cancer" (78.2%), yet only 24.8% acquainted good knowledge about urinary bladder cancer. Conclusion: We found that the citizens in Saudi Arabia have insufficient knowledge of urinary bladder cancer and its detriments.

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OBJECTIVE: The aim of this study was to assess the efficacy and safety of mirabegron as a medical expulsive therapy in patients with distal ureteral stones of 5-10 mm size. MATERIAL AND METHODS: A prospective, comparative study included 96 patients with radiopaque distal ure- teral stones of 5-10 mm who were randomly allocated and treated by medical expulsive therapy in 2 groups from January 2019 to December 2020. Patients in group A received only ketorolac 30 mg/day for 5 days, then on demand. Patients in group B received mirabegron 50 mg/day for 4 weeks plus ketorolac 30 mg/day like in group A. The stone expulsion rate was the primary outcome. RESULTS: There were no significant differences regarding age, gender, body mass index, laterality, degree of hydronephrosis, and stone size. After 4 weeks, stone expulsion rate was 52.1% for group A versus 89.6% for group B (P < .001). The median (range) of time to stone expulsion was 14 (13-23) and 7 (3-16) days for groups A and B, respectively (P = .004). The medians (range; interquartile range) of episodes of renal pain (1 (0-2; 1) vs. (0-2; 2); P < .001) and extra analgesic ampoules (1 (0-7; 4) vs. 0 (0-2; 0) vials; P < .001) were significantly higher in group A than those in group B, respectively. In multivariate analysis, only medical expulsive therapy (P <.001) and stone size (P < .001) were independent predictors of stone expulsion rate. CONCLUSION: Mirabegron is an effective and safe medical expulsive therapy agent in patients with 5-10 mm distal ureteral stones.

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Objectives To compare the outcomes of bladder preservation therapy with early or deferred radical cystectomy (RC) in high-grade non-muscle invasive bladder cancer. Methods Prospectively collected data were obtained for patients undergoing transurethral resection of bladder tumor (TURBT) at a tertiary care center between 2007 and 2018. Patients with a high-grade tumor (HGT1) were divided into three groups, depending on the treatment plan: conservative (GI), early RC (GII), or deferred RC (GIII). Kaplan-Meier analysis was performed to assess the cancer-specific survival (CSS). Results Seventy-one patients were included, and the patients had a median (range) age of 49 (32-72) years. The GI, GII, and GIII groups included 34 (47.9%), 14 (19.7%), and 23 (32.4%) patients, respectively. A significantly lower number of GII patients underwent >2 TURBTs (14.3% vs. 100%, p<0.001). Compared to GIII patients, GII patients had a shorter time to RC from the initial diagnosis (5.7 vs. 36.2 months, p=0.03). Ileal conduit and orthotropic bladder diversions were comparable between both groups, with significantly higher postoperative complications in GIII patients. The median (IQR) follow-up times for the groups were 84 (49-102), 82 (52-112), and 73 (36-89) months, respectively. The five-year and 10-year CSS for GII and GIII patients was 79% vs. 75% and 78% vs. 64%, respectively (log rank=0.19). Conclusion Early RC should be considered an alternative treatment option in selected patients with HGT1 BC with expected longer life expectancy, which may significantly decrease postoperative complications and improve the CSS. However, selection bias in the current retrospective study may influence these outcomes.

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OBJECTIVES: To evaluate the general knowledge among primary health care (PHC) physicians regarding the management of common urological problems in Saudi Arabia. METHODS: This is an observational prospective study, where a self-administered questionnaire was distributed to practicing PHC physicians in the western region of Saudi Arabia on January 2017. The questionnaire consisted of 21-item questions, inquiring about demographics and general urological knowledge and skills. The management of common urological problems was assessed by case scenarios for specific urological condition, including urethral catheterization, definition and evaluation of hematuria, recognition of age-specific increase in prostatic specific antigen (PSA), and management of lower urinary tract symptoms. Results: A total of 148 questionnaires were distributed, with a response rate of 75.7%, where 112 respondents completed the questionnaires,  including 54.3% residents, 39% general practitioners, and 5.4% specialists. Fifty-seven percent of respondents were males and 68% were Saudi practitioners. A higher number of respondents expressed that they were able to catheterize a male than female patient (56.5% versus 34.3%). Only 6.4% of respondents defined microscopic hematuria accurately. Knowledge about hematuria, serum prostate specific antigen and overactive bladder was low in all groups. Apart from hematuria, seeking urological consultations was less than 35% for all other disease entities. CONCLUSION: Urological knowledge among PHC physicians seems to be insufficient. Significant percentages of the participants were unable to catheterize a female patient, did not know the definition of hematuria; and whether to ask for urological consultations in cases of hematuria, increased PSA, and overactive bladder.

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BACKGROUND: Nephrolithiasis is a common condition that has various classifications according to stone composition. Stone formation can affect renal function; it can be a strong risk factor for chronic kidney disease (CKD). The main objective of this study is to explore the association between creatinine clearance and different stone compositions. METHODS: This is a retrospective cohort study conducted in a tertiary center in Jeddah, Saudi Arabia, between 2005 and 2014. Renal function was assessed by the estimating glomerular filtration rate (eGFR) by the Cockcroft-Gault equation. Stone composition was determined by urinary calculi analysis with infrared spectrometry. RESULTS: Stones of 365 patients, with a mean age of 48.2 ± 13.6 years and a male to female ratio of 3.2:1, were analyzed. Stage 2 CKD has been documented. It involved oxalate, struvite, cystine, and uric acid stones. The worst eGFR was reported for stones containing uric acid. The eGFR was least affected with apatite stones followed by brushite stones. CONCLUSION: Stone disease can affect renal function. Different stone compositions show factor for renal impairment, and this should be considered in patient management. A special precaution should be considered for higher risk groups. Multidisciplinary patient care and immediate referral to a nephrologist are strongly advised.

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We evaluated the associations between seven single nucleotide polymorphisms and susceptibility to urothelial bladder carcinoma (UBC) in a Saudi population. Genomic DNA was taken from buccal cells of 52 patients with UBC and 104 controls for genotyping of GSTT1, GSTM1, rs4646903, rs1048943, TP53 rs1042522, rs1801133, and rs1801394 using PCR and TaqMan® assays. The rs1801133 and rs1801394 variants showed strong associations with UBC (OR = 2.3, P = 0.0002; OR = 2.6, P = 0.0001, resp.). Homozygosity of Pro72 conferred a significant double risk in cases compared with controls (30.8% versus 15.4%), but the homozygote Arg/Arg had no effect on risk. Genotypic combinations of GSTM1/GSTT1, rs4646903/rs1048943, and rs1801133/rs1801394 exhibited significant linkage with the disease (χ2 = 10.3, P = 0.006; χ2 = 13.9, P = 0.003; and χ2 = 20.4, P = 0.0004, resp.). The GSTM1 and rs1042522Arg and rs1801394G variant alleles were more frequent in current smokers with UBC (52.4%, 52.5%, and 64.3%, resp.) than were the corresponding wild-types. Despite some variants having only a slight effect on UBC risk, the interaction effect of combined genetic biomarkers-or even the presence of one copy of a variant allele-is potentially much greater. Perhaps more studies regarding next-generation genetic sequencing and its utility can add to the risk of UBC.

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