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Prostatic urethral fibroepithelial polyps are quite rare congenital lesions of the male urethra. Most cases have been described in children. However, adult cases have also been reported. Herein, we report a case of a 24-year-old male who presented with voiding lower urinary tract symptoms and was finally diagnosed to have a prostatic urethral fibroepithelial polyp. He was treated with a bladder neck preserving transurethral resection, with no recurrence after one year of follow-up. The rare cause, in addition, the modified approach, encouraged us to report this case.

Faris Abushamma,1,2 Mahfouz Ktaifan,1 Abdoh Abdallah,1 Mohammad Alkarajeh,1 Mosab Maree,1,3 Ahmed Awadghanem,1,3 Ahmad Jaradat,1,2 Amir Aghbar,1,2 Sa’ed H Zyoud,4,5 Francis X Keeley Jr6 1Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine; 2Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine; 3Department of Radiology, An-Najah National University Hospital, Nablus, 44839, Palestine; 4Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine; 5Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine; 6Bristol Urological Institute, North Bristol NHS Trust, Bristol, UKCorrespondence: Faris AbushammaDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, PalestineEmail farisabushamma@hotmail.comPurpose: Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non-complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC.Patients and Methods: This was an observational and retrospective cohort study. Patients with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI.Results: One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17;p< 0.001). High CRP level is also significantly associated with EI (n=36; 86%; p< 0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%;p< 0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6– 13mm), and HU density of stone of 700 (430– 990) H.U (p< 0.001). Ureteric stone volume of 0.2 (0.06– 0.3) cm3 is significantly associated with EI (p< 0.001). Ureteral wall thickness of 3 (2– 3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13– 28 mm) are all significantly associated with a higher rate of EI (p< 0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI.Conclusion: MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.Keywords: ureteral calculi, medical expulsive therapy, spontaneous stone passage, maximal length of ureteral calculi, pyonephrosis

Faris Abushamma,1,2 Narjis Nassar,1 Sulafa Omar Najjar,1 Sobhe Mahmoud Hijaze,1 Amer Koni,3,4 Sa’ed H Zyoud,4– 6 Amir Aghbar,1,2 Rifat Hanbali,7 Hashim Hashim8 1Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine; 2Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine; 3Division of Clinical Pharmacy, Hematology and Oncology Department, An-Najah National University Hospital, Nablus, 44839, Palestine; 4Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine; 5Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine; 6Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine; 7Department of Rheumatology, An-Najah National University Hospital, Nablus, 44839, Palestine; 8Bristol Urological Institute, North Bristol NHS Trust, Bristol, UKCorrespondence: Faris AbushammaDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, PalestineEmail farisabushamma@hotmail.comPurpose: To assess the presence of lower urinary tract symptoms (LUTS) in rheumatoid arthritis (RA) female patients with assessment of LUTS and its impact on quality of life (QoL).Patients and Methods: A prospective, cross-sectional study of female patients with RA was conducted. Demographics and clinical data, Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS), and the RA Disease Activity Score 28 (DAS28) were all collected. A correlation has been made between all variables to assess the factors that induce LUTS in RA and the impact on QoL.Results: Eighty-nine patients were enrolled. About 94.4% of RA patients had at least one symptom of LUTS. Concerning DAS28, 55.1% had moderate disease activity and 16.9% had high disease activity, which was not significantly associated with BFLUTS or QoL. The prevalence of overactive bladder syndrome symptoms (OAB: frequency, urgency, nocturia, and urgency incontinence) were found to be 65.2%, 59.6%, 56.2%, and 30.3%, respectively. Stress incontinence was prevalent in 40.4% of patients. The overall interference with life was evident in 27 (30.3%) patients secondary to LUTS. Body mass index (BMI) was positively and significantly correlated with the presence of storage symptoms (r = 0.306, p = 0.004) and with the total BFLUTS (r = 0.251, p = 0.018). BFLUTS subdomains and total scores were significantly correlated to poor QoL. The correlation of the BFLUTS QoL was found to be r = 0.584, p < 0.001 with storage symptoms, r = 0.399, p < 0.001 with voiding symptoms, and r = 0.757, p < 0.001 with incontinence.Conclusion: LUTS is a prominent and significant disability that directly affects QoL in RA. BMI is an independent factor that is linked to LUTS in RA patients.Keywords: lower urinary tract symptoms, rheumatoid arthritis, quality of life, DAS28, BFLUTS, overactive bladder

Objectives Metabolic Syndrome “MetS” is characterized by the presence of several factors that play a major role in the development of cardiovascular diseases and diabetes mellitus. This study was conducted to establish the prevalence of MetS and its individual components among the overweight and obese students at An-Najah National University (ANU) using IDF and modified NCEP ATP III definition and to identify conditions associated with it. Materials and methods A cross-sectional study was conducted in 2016. Data were collected in two stages: first stage included anthropometric and blood pressure measurements for 850 participants. Second stage included a self-administered questionnaire and biochemical analysis for only overweight or obese (154) participants. Results The prevalence of overweight and obesity was 26.2%, with significant increase among males (36.4%) compared with females (19.1%). The prevalence of MetS among obese and overweight was (28.6%) according to IDF with no significant increase compared to NCEP ATP criteria (24%). Reduced HDL- cholesterol was the most prevalent component (74.7%) in obese and overweight participants followed by central obesity (72.1%), raised blood pressure (29.9%), elevated fasting blood sugar (24%), and lastly increased triglycerides (18.2%). No significant differences were found between males and females according to both criteria. Moreover, no significant associations with geographic locality, house-hold income, smoking, physical activity, or family history were determined. Conclusions The prevalence of MetS among overweight and obese young adult Palestinians was high and demands immediate intervention, given the potential for these adults to develop chronic diseases.

Background Metabolic syndrome is characterised by the presence of several metabolic abnormalities, including hyperglycaemia, central obesity (also known as abdominal obesity), elevated blood pressure, and an abnormal blood lipid profile. The prevalence of metabolic syndrome is rising rapidly around the world as childhood obesity is increasing. The aim of this study is to determine the prevalence of metabolic syndrome in school children aged 6–18 years residing in Ein Alhelwe Refugee camp in Saida, Lebanon. Methods School children aged 6–18 years from the first to twelfth grades from two United Nations Relief and Works Agency (UNRWA) schools were randomly chosen. We used a school-based cross-sectional study design with two stages. The first stage included measurements of weight, height, body mass index (BMI), waist circumference, and blood pressure. In the second stage, blood tests were carried out for fasting blood sugar, triglycerides, and high-density lipoprotein (HDL). Approval was obtained from the ethics committee at Al Hamshari Hospital in Saida, Lebanon. Written permission was obtained from the UNRWA and the principals of the two schools for the first stage, and informed written consent was obtained from parents on behalf of the children involved in the second stage of the study. Findings The first stage of the research included 487 participants (258 female, 229 male) and the second stage included 73 participants (36 overweight participants [12 male, 24 female] and 37 obese participants [19 male, 18 female]). The prevalence of overweight and obesity were 15·2% (74 of 487) and 14·4% (70 of 487) among all age groups, respectively. Among Palestinian refugee school children in Saida aged 10–18 years, the prevalence of metabolic syndrome was more pronounced when the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) definition was used (30·9%; 21 of 68) compared to the International Diabetes Federation (IDF) definition (11·8%; eight of 68), with no statistical differences between male and female participants. Note that the IDF definition can be applied to children aged 10–18 years, of whom there were 68 participants, and for comparison between IDF and NCEP ATP-III, prevalence of metabolic syndrome was calculated for participants in this age range. Low HDL cholesterol (52·1%; 38 of 73), central obesity (46·6%; 34 of 73), and raised blood pressure (42·5%; 31 of 73) were the leading three common metabolic abnormalities among children who were overweight or obese. Interpretation This study has shown that metabolic syndrome is common among children who are obese or overweight, who are aged 10–18 years, living in Ein Al-Helwa Refugee Camp in Saida, Lebanon. These data raise the importance of early prevention and treatment of metabolic syndrome and its components (abdominal obesity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated blood glucose) to reduce the risk of diabetes and cardiovascular complications in susceptible individuals. A potential limitation of this study is that the small sample size may not accurately reflect the prevalence of metabolic syndrome. Funding Palestinian Civil Society Organizations Commission, Life Hope Center, and Palestinian Red Crescent Society Al Hamshari Hospital.