Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcin... more Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcinoma? a prospective comparative study
Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy f... more Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1 % by local infiltration as a monotherapy during renal ESWL and ensure stone clearance after the procedure. Methods: One hundred patients with renal stones, aged 18 to 65 years, were randomly allocated into two groups; 49 patients in group 1 received intramuscular injection of 20 mg Ketorolac tromethamine, 20 minutes before start of the procedure and 51 patients in group 2 received Lidocaine 1 % by local infiltration (5mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. A visual analog scale, (0 to 100 mm) was used to evaluate pain every 10 minutes. Results: The visual analog scores for group 2 were significantly lower than (group 1) at 10, 20, 30 and 40 minutes till end of the proc...
Study Type--Therapy (case series) Level of Evidence 4. What&a... more Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The minimally invasive percutaneous nephrolitholapaxy (MIP) has shown high efficacy and safety for the management of small renal stones. It was initially developed to overcome a gap between the minimally invasive extracorporeal shockwave lithotripsy and invasive conventional percutaneous nephrolitholapaxy (PCNL) in the management of low stone burden but there is debate as to whether the MIP is also effective for larger stones. The present study shows the high efficacy and safety of MIP, which is comparable to conventional PCNL in the treatment of stones of >20 mm, including complex staghorn stones. • To evaluate the safety and efficacy of minimally invasive percutaneous nephrolitholapaxy (MIP) in the management of large and complex renal calculi. • From January 2007 to March 2011, 73 patients with 83 renal units with large renal stones (>20 mm in diameter) were retrospectively evaluated. • Stones were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvis stones with accompanying calyceal stones). • Stone-free rate, complications according to the modified Clavien system, decrease in haemoglobin, creatinine level, operative duration and hospital stay were compared for simple and complex renal calculi. • The mean (sd) stone size was 36.7 (23.37) mm and mean operative duration was 99.2 (48.3) min. • In all, 65 cases (78.3%) were stone-free after the first procedure and another 14 needed an auxiliary procedure (four second-look percutaneous nephrolitholapaxy, nine ureterorenoscopy, and one extracorporeal shockwave lithotripsy) to become stone-free, resulting in a 95.2% stone-free rate. • Complications occurred in 22 procedures (26.5%), 17 of them were Clavien Grade 1 or 2 (20.5%), five were Grade 3 (6%). There were no Grade 4 or 5 complications. • The only significant difference between complex and simple stones was the stone-free rate (96.9% vs 66.7%, P = 0.001). • The MIP technique is effective and safe for larger stones with low morbidity, good success rate and reasonable operative duration.
Introduction Removal of stone in patients with coexistent renal insufficiency improves the functi... more Introduction Removal of stone in patients with coexistent renal insufficiency improves the function of the kidney in most of the cases. Percutaneous nephrolithotomy (PCNL) is considered a suitable minimally invasive treatment option in these patients with minimum morbidity and mortality. Patients and methods This was a prospective study conducted in Assiut University Hospital, Egypt, from March 2015 to March 2018 to assess the efficacy and safety of PCNL in patients with chronic kidney disease (CKD) and patients with unilateral poorly functioning kidney (UPFK). The authors recruited patients aged greater than or equal to 18 years, with renal stone with either CKD or UPFK. All patients were managed with PCNL. Primary outcomes were stone clearance and complications rates. Secondary outcomes were serum creatinine and estimated glomerular filtration rate. Data collected were analyzed using Statistical Package for the Social Sciences 20 software. P value was considered significant if les...
The aim of this article is to compare the results of high varix ligation with and without sclerot... more The aim of this article is to compare the results of high varix ligation with and without sclerotherapy. Between November 2014 and December 2015, sixty patients with varicocele were included in this study. Patients were divided into two equal groups; group I (underwent high varix ligation), and group II (underwent high varix ligation with a retrograde injection of 2 mL of 5% ethanolamine oleate in the lower end of the bisected gonadal vein). The operative time, intra- and postoperative complications, postoperative pain, improvement of semen parameters, incidence of recurrence and achieving of unassisted pregnancy were recorded for both groups. The age range was 19-34 years in group I and 21-37 years in group II. The operative time was shorter in group I (34.6 ±7.81 min) than group II (43.3 ±8.5 min) (P <0.001), which was statistically significant.Improvement of semen parameters and the occurrence of spontaneous pregnancy were insignificant between both groups. No intraoperative c...
To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethropla... more To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethroplasty for distal hypospadias repair. Patients and methods: In a prospective randomised study, 60 patients with coronal, subcoronal and distal penile hypospadias, with a urethral plate width of 66 mm, and minimal or no chordee, underwent either MOIF using a midline longitudinal outer preputial skin flap passed ventrally by penile buttonholing through dartos fascia incision, or a Mathieu urethroplasty. Closed envelopes were used for randomly selecting patients for each procedure. The operative duration, complications, cosmetic outcome, urinary stream and relatives' satisfaction were reported for each procedure. Results: Preoperative data (patients' age and site of urethral meatus) and operative duration were insignificantly different between the groups (P = 0.653, 0.786 and 0.710, respectively). There were no intraoperative complications in either group. The duration of follow-up was insignificantly different between the groups. Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).
The Open Access Journal of Science and Technology, 2014
Renal stone disease is one of the common diseases worldwide. Treatment of renal stones is widely ... more Renal stone disease is one of the common diseases worldwide. Treatment of renal stones is widely variable. It changed markedly during the last three decades from the more invasive open surgery to the less invasive procedures such as shock wave lithotripsy, percutaneous nephrolithotripsy and recently retrograde intrarenal surgery. Though less invasive, these techniques are more commonly associated with residual fragments after therapy. Larger fragments are considered treatment failure and need retreatment. Conversely, smaller fragments are usually clinically insignificant and might be considered acceptable outcome. Still, these insignificant fragments might become clinically significant or cause complications. In this article, we reviewed the available literature in a trial to report features of these residual fragments, their clinical significance, their incidence after the commonly performed minimally invasive renal stone therapy, the different imaging modalities used to detect these fragments, the fate of these fragment and the possible lines of management if these fragments are detected.
Pediatric nephrolithiasis is increasing globally and is endemic in developing countries. It is us... more Pediatric nephrolithiasis is increasing globally and is endemic in developing countries. It is usually associated with urinary tract infection (UTI), anatomical and metabolic abnormalities, together with climate and dietary factors. Therefore, nephrolithiasis in children has a high rate of recurrence; with an overall 5-year recurrence rate of 55% (95% confidence interval: 38-70%). [1,2] The treatment options for pediatric stones are shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PNL) and open/laparoscopic stone surgery. The ideal treatment modality is that with high stone clearance rate and low morbidity. In view of this, SWL is generally preferred for renal stone <1 cm and PNL offers Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.
The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in compari... more The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.
A questionnaire study was carried out to compare the health-related quality of life after contine... more A questionnaire study was carried out to compare the health-related quality of life after continent urinary diversion using a Kock pouch with that following ileal conduit diversion. 76 patients completed the questionnaire: 26 patients had a continent and 50 an ileal conduit ...
To determine the sensitivity and specificity of different ultrasound (US) modalities in predictin... more To determine the sensitivity and specificity of different ultrasound (US) modalities in predicting an obstructive vs a nonobstructive etiology of azoospermia. A total of 268 azoospermic men with available histopathologic slides were separated into obstructive (n = 104) and nonobstructive (n = 164) groups. Scrotal US studies, including color Doppler and transrectal US examinations, were performed in all patients and compared with the testicular biopsy results as the reference standard. We found that a decreased testicular volume and intra- and extratesticular varicocele were the most common abnormalities detected using scrotal US in those with nonobstructive azoospermia. In contrast, epididymitis, spermatocele, and duct ectasia were the most common findings in those with obstructive azoospermia. The sensitivity and specificity of scrotal US in detecting nonobstructive azoospermia was 75% and 72%, respectively, and for detecting obstructive azoospermia was 29.8% and 87%, respectively. Prostatic midline cysts, ejaculatory duct calcification, dilated seminal vesicle, and/or vassal ampullae were the most common abnormalities detected using transrectal US for obstructive azoospermia. The sensitivity and specificity of transrectal US in detecting obstructive etiology was 45% and 83%, respectively, and for functional etiology was 39% and 88%, respectively. Scrotal US was more sensitive in detecting functional azoospermia and more specific in detecting obstructive azoospermia. However, transrectal US was more sensitive in detecting obstructive azoospermia and more specific in detecting functional azoospermia. Both tests had greater specificity than sensitivity for obstructive azoospermia, indicating that US has the ability to exclude more than to diagnose cases of obstructive azoospermia. However, US is unlikely to completely replace testicular biopsy.
Introduction: The incidence of incisional hernia depends on many factors factors including old ag... more Introduction: The incidence of incisional hernia depends on many factors factors including old age, sex, obesity, bowel surgery, suture type, chest infection, abdominal distension and wound infection. Case report: A 55 years old woman presented at out institute, she had an operation 19 years ago-elsewhere-to remove a branched stone from her right kidney and admitted for two months into the hospital at this time as she had troubles with her surgical wound and she had repeated secondary sutures. The hernia is in the right lumbar region, has a smooth surface, shows expansile impulse on coughing, there are some dilated veins on its surface, there is no tenderness, it has a uniform consistency, mobile, there are no pulsations, it contains large and small intestine, partially reducible, the defect is about 10 cm in diameter and there are no complications. This woman had left nephrectomy two years ago as a treatment for painful non functioning kidney and she is living now with only functioning right kidney with serum creatinine 1.1 mg % and blood urea 38 mg %. Conclusion: Incisional hernia is a very common complication of wound healing after surgery. Good care and precautions are very important to avoid its development.
Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line... more Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1% ...
Objectives To examine the usefulness of smoothelin — a new immunohistochemical (IHC) marker that... more Objectives To examine the usefulness of smoothelin — a new immunohistochemical (IHC) marker that is expressed predominantly in visceral smooth muscle — in recognizing muscularis propria (MP) in transurethral resection (TUR) and matched cystectomy specimens and to compare the pattern of its expression in muscularis mucosae (MM) and MP in radical cystectomy specimens. Methods IHC staining for smoothelin was performed in 49
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What ... more Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The minimally invasive percutaneous nephrolitholapaxy (MIP) has shown high efficacy and safety for the management of small renal stones. It was initially developed to overcome a gap between the minimally invasive extracorporeal shockwave lithotripsy and invasive conventional percutaneous nephrolitholapaxy (PCNL) in the management of low stone burden but there is debate as to whether the MIP is also effective for larger stones. The present study shows the high efficacy and safety of MIP, which is comparable to conventional PCNL in the treatment of stones of >20 mm, including complex staghorn stones. • To evaluate the safety and efficacy of minimally invasive percutaneous nephrolitholapaxy (MIP) in the management of large and complex renal calculi. • From January 2007 to March 2011, 73 patients with 83 renal units with large renal stones (>20 mm in diameter) were ...
prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra... more prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra; (e) adenocarcinoma of the prostate left in situ after surgery. Moreover, from a functional point of view, prostate-and seminal-sparing cystectomy has been associated with an increased risk of self-intermittent catheterization for the neobladder outlet obstruction caused by the prostatic tissue. 10 Therefore, prostatic invasion by SCC, if present, should be considered only one factor contraindicating prostate-and seminal-sparing cystectomy, and other important limitations exist and should be considered before offering such a procedure to patients with SCC.
The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ur... more The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ureteral stones is around 81% when treated by either SWL or ureteroscopy (URS).
prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra... more prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra; (e) adenocarcinoma of the prostate left in situ after surgery. Moreover, from a functional point of view, prostate-and seminal-sparing cystectomy has been associated with an increased risk of self-intermittent catheterization for the neobladder outlet obstruction caused by the prostatic tissue. 10 Therefore, prostatic invasion by SCC, if present, should be considered only one factor contraindicating prostate-and seminal-sparing cystectomy, and other important limitations exist and should be considered before offering such a procedure to patients with SCC.
Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcin... more Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcinoma? a prospective comparative study
Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy f... more Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1 % by local infiltration as a monotherapy during renal ESWL and ensure stone clearance after the procedure. Methods: One hundred patients with renal stones, aged 18 to 65 years, were randomly allocated into two groups; 49 patients in group 1 received intramuscular injection of 20 mg Ketorolac tromethamine, 20 minutes before start of the procedure and 51 patients in group 2 received Lidocaine 1 % by local infiltration (5mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. A visual analog scale, (0 to 100 mm) was used to evaluate pain every 10 minutes. Results: The visual analog scores for group 2 were significantly lower than (group 1) at 10, 20, 30 and 40 minutes till end of the proc...
Study Type--Therapy (case series) Level of Evidence 4. What&amp;amp;amp;amp;amp;amp;amp;amp;a... more Study Type--Therapy (case series) Level of Evidence 4. What&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s known on the subject? and What does the study add? The minimally invasive percutaneous nephrolitholapaxy (MIP) has shown high efficacy and safety for the management of small renal stones. It was initially developed to overcome a gap between the minimally invasive extracorporeal shockwave lithotripsy and invasive conventional percutaneous nephrolitholapaxy (PCNL) in the management of low stone burden but there is debate as to whether the MIP is also effective for larger stones. The present study shows the high efficacy and safety of MIP, which is comparable to conventional PCNL in the treatment of stones of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 mm, including complex staghorn stones. • To evaluate the safety and efficacy of minimally invasive percutaneous nephrolitholapaxy (MIP) in the management of large and complex renal calculi. • From January 2007 to March 2011, 73 patients with 83 renal units with large renal stones (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 mm in diameter) were retrospectively evaluated. • Stones were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvis stones with accompanying calyceal stones). • Stone-free rate, complications according to the modified Clavien system, decrease in haemoglobin, creatinine level, operative duration and hospital stay were compared for simple and complex renal calculi. • The mean (sd) stone size was 36.7 (23.37) mm and mean operative duration was 99.2 (48.3) min. • In all, 65 cases (78.3%) were stone-free after the first procedure and another 14 needed an auxiliary procedure (four second-look percutaneous nephrolitholapaxy, nine ureterorenoscopy, and one extracorporeal shockwave lithotripsy) to become stone-free, resulting in a 95.2% stone-free rate. • Complications occurred in 22 procedures (26.5%), 17 of them were Clavien Grade 1 or 2 (20.5%), five were Grade 3 (6%). There were no Grade 4 or 5 complications. • The only significant difference between complex and simple stones was the stone-free rate (96.9% vs 66.7%, P = 0.001). • The MIP technique is effective and safe for larger stones with low morbidity, good success rate and reasonable operative duration.
Introduction Removal of stone in patients with coexistent renal insufficiency improves the functi... more Introduction Removal of stone in patients with coexistent renal insufficiency improves the function of the kidney in most of the cases. Percutaneous nephrolithotomy (PCNL) is considered a suitable minimally invasive treatment option in these patients with minimum morbidity and mortality. Patients and methods This was a prospective study conducted in Assiut University Hospital, Egypt, from March 2015 to March 2018 to assess the efficacy and safety of PCNL in patients with chronic kidney disease (CKD) and patients with unilateral poorly functioning kidney (UPFK). The authors recruited patients aged greater than or equal to 18 years, with renal stone with either CKD or UPFK. All patients were managed with PCNL. Primary outcomes were stone clearance and complications rates. Secondary outcomes were serum creatinine and estimated glomerular filtration rate. Data collected were analyzed using Statistical Package for the Social Sciences 20 software. P value was considered significant if les...
The aim of this article is to compare the results of high varix ligation with and without sclerot... more The aim of this article is to compare the results of high varix ligation with and without sclerotherapy. Between November 2014 and December 2015, sixty patients with varicocele were included in this study. Patients were divided into two equal groups; group I (underwent high varix ligation), and group II (underwent high varix ligation with a retrograde injection of 2 mL of 5% ethanolamine oleate in the lower end of the bisected gonadal vein). The operative time, intra- and postoperative complications, postoperative pain, improvement of semen parameters, incidence of recurrence and achieving of unassisted pregnancy were recorded for both groups. The age range was 19-34 years in group I and 21-37 years in group II. The operative time was shorter in group I (34.6 ±7.81 min) than group II (43.3 ±8.5 min) (P <0.001), which was statistically significant.Improvement of semen parameters and the occurrence of spontaneous pregnancy were insignificant between both groups. No intraoperative c...
To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethropla... more To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethroplasty for distal hypospadias repair. Patients and methods: In a prospective randomised study, 60 patients with coronal, subcoronal and distal penile hypospadias, with a urethral plate width of 66 mm, and minimal or no chordee, underwent either MOIF using a midline longitudinal outer preputial skin flap passed ventrally by penile buttonholing through dartos fascia incision, or a Mathieu urethroplasty. Closed envelopes were used for randomly selecting patients for each procedure. The operative duration, complications, cosmetic outcome, urinary stream and relatives' satisfaction were reported for each procedure. Results: Preoperative data (patients' age and site of urethral meatus) and operative duration were insignificantly different between the groups (P = 0.653, 0.786 and 0.710, respectively). There were no intraoperative complications in either group. The duration of follow-up was insignificantly different between the groups. Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).
The Open Access Journal of Science and Technology, 2014
Renal stone disease is one of the common diseases worldwide. Treatment of renal stones is widely ... more Renal stone disease is one of the common diseases worldwide. Treatment of renal stones is widely variable. It changed markedly during the last three decades from the more invasive open surgery to the less invasive procedures such as shock wave lithotripsy, percutaneous nephrolithotripsy and recently retrograde intrarenal surgery. Though less invasive, these techniques are more commonly associated with residual fragments after therapy. Larger fragments are considered treatment failure and need retreatment. Conversely, smaller fragments are usually clinically insignificant and might be considered acceptable outcome. Still, these insignificant fragments might become clinically significant or cause complications. In this article, we reviewed the available literature in a trial to report features of these residual fragments, their clinical significance, their incidence after the commonly performed minimally invasive renal stone therapy, the different imaging modalities used to detect these fragments, the fate of these fragment and the possible lines of management if these fragments are detected.
Pediatric nephrolithiasis is increasing globally and is endemic in developing countries. It is us... more Pediatric nephrolithiasis is increasing globally and is endemic in developing countries. It is usually associated with urinary tract infection (UTI), anatomical and metabolic abnormalities, together with climate and dietary factors. Therefore, nephrolithiasis in children has a high rate of recurrence; with an overall 5-year recurrence rate of 55% (95% confidence interval: 38-70%). [1,2] The treatment options for pediatric stones are shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PNL) and open/laparoscopic stone surgery. The ideal treatment modality is that with high stone clearance rate and low morbidity. In view of this, SWL is generally preferred for renal stone <1 cm and PNL offers Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.
The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in compari... more The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.
A questionnaire study was carried out to compare the health-related quality of life after contine... more A questionnaire study was carried out to compare the health-related quality of life after continent urinary diversion using a Kock pouch with that following ileal conduit diversion. 76 patients completed the questionnaire: 26 patients had a continent and 50 an ileal conduit ...
To determine the sensitivity and specificity of different ultrasound (US) modalities in predictin... more To determine the sensitivity and specificity of different ultrasound (US) modalities in predicting an obstructive vs a nonobstructive etiology of azoospermia. A total of 268 azoospermic men with available histopathologic slides were separated into obstructive (n = 104) and nonobstructive (n = 164) groups. Scrotal US studies, including color Doppler and transrectal US examinations, were performed in all patients and compared with the testicular biopsy results as the reference standard. We found that a decreased testicular volume and intra- and extratesticular varicocele were the most common abnormalities detected using scrotal US in those with nonobstructive azoospermia. In contrast, epididymitis, spermatocele, and duct ectasia were the most common findings in those with obstructive azoospermia. The sensitivity and specificity of scrotal US in detecting nonobstructive azoospermia was 75% and 72%, respectively, and for detecting obstructive azoospermia was 29.8% and 87%, respectively. Prostatic midline cysts, ejaculatory duct calcification, dilated seminal vesicle, and/or vassal ampullae were the most common abnormalities detected using transrectal US for obstructive azoospermia. The sensitivity and specificity of transrectal US in detecting obstructive etiology was 45% and 83%, respectively, and for functional etiology was 39% and 88%, respectively. Scrotal US was more sensitive in detecting functional azoospermia and more specific in detecting obstructive azoospermia. However, transrectal US was more sensitive in detecting obstructive azoospermia and more specific in detecting functional azoospermia. Both tests had greater specificity than sensitivity for obstructive azoospermia, indicating that US has the ability to exclude more than to diagnose cases of obstructive azoospermia. However, US is unlikely to completely replace testicular biopsy.
Introduction: The incidence of incisional hernia depends on many factors factors including old ag... more Introduction: The incidence of incisional hernia depends on many factors factors including old age, sex, obesity, bowel surgery, suture type, chest infection, abdominal distension and wound infection. Case report: A 55 years old woman presented at out institute, she had an operation 19 years ago-elsewhere-to remove a branched stone from her right kidney and admitted for two months into the hospital at this time as she had troubles with her surgical wound and she had repeated secondary sutures. The hernia is in the right lumbar region, has a smooth surface, shows expansile impulse on coughing, there are some dilated veins on its surface, there is no tenderness, it has a uniform consistency, mobile, there are no pulsations, it contains large and small intestine, partially reducible, the defect is about 10 cm in diameter and there are no complications. This woman had left nephrectomy two years ago as a treatment for painful non functioning kidney and she is living now with only functioning right kidney with serum creatinine 1.1 mg % and blood urea 38 mg %. Conclusion: Incisional hernia is a very common complication of wound healing after surgery. Good care and precautions are very important to avoid its development.
Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line... more Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1% ...
Objectives To examine the usefulness of smoothelin — a new immunohistochemical (IHC) marker that... more Objectives To examine the usefulness of smoothelin — a new immunohistochemical (IHC) marker that is expressed predominantly in visceral smooth muscle — in recognizing muscularis propria (MP) in transurethral resection (TUR) and matched cystectomy specimens and to compare the pattern of its expression in muscularis mucosae (MM) and MP in radical cystectomy specimens. Methods IHC staining for smoothelin was performed in 49
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What ... more Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The minimally invasive percutaneous nephrolitholapaxy (MIP) has shown high efficacy and safety for the management of small renal stones. It was initially developed to overcome a gap between the minimally invasive extracorporeal shockwave lithotripsy and invasive conventional percutaneous nephrolitholapaxy (PCNL) in the management of low stone burden but there is debate as to whether the MIP is also effective for larger stones. The present study shows the high efficacy and safety of MIP, which is comparable to conventional PCNL in the treatment of stones of >20 mm, including complex staghorn stones. • To evaluate the safety and efficacy of minimally invasive percutaneous nephrolitholapaxy (MIP) in the management of large and complex renal calculi. • From January 2007 to March 2011, 73 patients with 83 renal units with large renal stones (>20 mm in diameter) were ...
prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra... more prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra; (e) adenocarcinoma of the prostate left in situ after surgery. Moreover, from a functional point of view, prostate-and seminal-sparing cystectomy has been associated with an increased risk of self-intermittent catheterization for the neobladder outlet obstruction caused by the prostatic tissue. 10 Therefore, prostatic invasion by SCC, if present, should be considered only one factor contraindicating prostate-and seminal-sparing cystectomy, and other important limitations exist and should be considered before offering such a procedure to patients with SCC.
The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ur... more The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ureteral stones is around 81% when treated by either SWL or ureteroscopy (URS).
prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra... more prostate; (d) urethral recurrence due to preservation of the distal part of the prostatic urethra; (e) adenocarcinoma of the prostate left in situ after surgery. Moreover, from a functional point of view, prostate-and seminal-sparing cystectomy has been associated with an increased risk of self-intermittent catheterization for the neobladder outlet obstruction caused by the prostatic tissue. 10 Therefore, prostatic invasion by SCC, if present, should be considered only one factor contraindicating prostate-and seminal-sparing cystectomy, and other important limitations exist and should be considered before offering such a procedure to patients with SCC.
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Papers by Ehab Elganainy