Papers by Ahmed Mohamed Moeen
Pain Physician, 2019
Background: Intravenous lidocaine infusion (IVLI) reduces postoperative pain and hastens the retu... more Background: Intravenous lidocaine infusion (IVLI) reduces postoperative pain and hastens the return of bowel function. Objectives: We aimed to compare the effects of adding lidocaine infusion to enhanced recovery pathway (ERP) on acute rehabilitation protocol. Study Design: This study uses a double-blind, randomized design with allocation concealment in a 2-armed parallel group format among patients undergoing open radical cystectomy (RC). Setting: The study was conducted at Assiut University Hospital, Asyut, Egypt. The study duration was March 2017 to July 2018. Methods: After ethics committee approval, 111 patients, American Society of Anesthesiologists (ASA) physical status II-III, aged 45-65 years, scheduled for open RC with urinary diversion under an ERP, were randomly selected in a double-blind manner to receive IVLI 2 mg/minute for 4 hours or an equal volume of normal saline solution 0.9%. Postoperative pain scores, rescue analgesic consumption, times to return of bowel sound...
Annals of Pediatric Surgery
Background Testicular ectopia is defined as a testis which is located away from the normal pathwa... more Background Testicular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016. Results Out of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. T...
Central European Journal of Urology
Central European journal of urology, 2018
To assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) c... more To assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC). 102 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated. The cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10 mm/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (...
Archives in Cancer Research
Central European journal of urology, 2017
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...
Urology
To present our experience with concealed epispadias and to estimate its actual share in the isola... more To present our experience with concealed epispadias and to estimate its actual share in the isolated male epispadias cases and its effect on the surgical outcome. Consecutive patients with isolated male epispadias treated in our center between 2008 and 2015 were classified into concealed and classic epispadias. The 2 groups were compared regarding age at presentation, meatal location, incontinence, dorsal curvature, success rate, and complications. Out of 51 patients with isolated male epispadias, 11 (21.6%) were concealed: 7 balanic and 4 penile shaft epispadias. Concealed epispadias cases were found to have significantly delayed age at presentation, more distal meatal location, and less incontinence rate than classic epispadias cases. None of the surgical outcome parameters showed significant difference between the 2 groups. Concealed epispadias represents about one-fifth of isolated male epispadias cases. Impediment and delay of diagnosis are its main clinical impacts, with insignificant effect on the surgical outcome.
Scandinavian Journal of Urology, 2017
The aim of this study was to report the functional outcome after endoscopic management of neoblad... more The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.
Saudi Journal of Anaesthesia, 2017
Background: Multiple studies claim that caudal administration of ketamine causes effective postop... more Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6 th till 48 th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.
African Journal of Urology, 2015
Recurrent tumors inside an orthotopic ileal neobladder are rare, and only few cases have been rep... more Recurrent tumors inside an orthotopic ileal neobladder are rare, and only few cases have been reported in the literature. Herein, we report a case of recurrent transitional cell carcinoma in an orthotopic ileal neobladder discovered one and a half years after the operation.
Internal Medicine: Open Access, 2015
Postoperative cholestatic jaundice may occur immediately after surgical treatment of pyonephrosis... more Postoperative cholestatic jaundice may occur immediately after surgical treatment of pyonephrosis, but it is a rare condition. Convalescence is the role with no specific treatment. Herein, we report the occurrence of postoperative cholestatic jaundice in a thirty years old female patient after subcapsular nephrectomy for pyonephrosis.
Purpose: We evaluate the functional results of a new modification of Studer orthotopic neobladder... more Purpose: We evaluate the functional results of a new modification of Studer orthotopic neobladder made of smaller ileal segment in 15 males after radical cystectomy. Material and Methods: Radical cystectomy and orthotopic ileal neobladder creation was performed in 15 male patients for invasive bladder cancer. We modified the Studer technique using only 40 cm segment of the ileum; 32 cm segment for the pouch and 8 cm segment as an isoperistaltic intact limb for ureteral reimplantation. Of the patients, 13 were evaluable at a follow-up period of 24 months. Evaluation included clinical, radiographic and urodynamic studies to determine functional and oncological outcomes. Results: There was no perioperative or early postoperative deaths. Early complications occurred in one patient (6.7%) who developed poucho-intestinal fistula which was repaired 3 weeks after the operation. During the observation period there were 4 oncological failures (26.7%). Late complications included death in 2 ca...
Arab Journal of Urology, 2013
pletely dry after AC and oBTX, respectively. The overall and individual scores of the OAB-SAT-q w... more pletely dry after AC and oBTX, respectively. The overall and individual scores of the OAB-SAT-q were significantly higher among patients treated with AC than with oBTX. The incidence of the de novo need to use clean intermittent catheterisation after oBTX and AC was two of 16 and four of 15, respectively. Conclusions: Both procedures are effective in improving the symptoms of OAB and of quality of life, but patients were more satisfied with AC than oBTX therapy.
European Urology Supplements, 2013
meeting will also include analysis of outcome parameters in relation to first line treatment and ... more meeting will also include analysis of outcome parameters in relation to first line treatment and previously demonstrated second line prognostic factors and include approximately 100 patients from three Nordic centers.
Scandinavian journal of …, 1994
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 ...
The Journal of Urology, 2013
INTRODUCTION AND OBJECTIVES: In developed countries, numerous minimally invasive procedures are a... more INTRODUCTION AND OBJECTIVES: In developed countries, numerous minimally invasive procedures are available for refractory Overactive bladder (OAB). Augmentation ileocystoplat (AC) remains an option for cultural and economic reasons in other countries. This study aimed to evaluate preoperative urodynamic variables that may predict subjects with refractory idiopathic OAB who may need CIC after AC. METHODS: Patients with refractory idiopathic urodynamically proven OAB completed UDI-6 and IIQ-7 questionnaires, urodynamics and post-void residual urine assessment before and 6 months after AC. Excluded from our study are subjects with suspected neurological deficit. RESULTS: 13 patients underwent augmentation cystoplasty for refractory OAB. Rate of De novo CIC after augmentation is 30% (n 4). Peak flow rate (Qmax) and detrusor pressure at Qmax were significantly higher among subjects who did not need CIC compared to those who needed CIC after augmentation (see table). In addition, the Qmax occurs during the down limb of the Pdet curve during voiding (see Figure). CONCLUSIONS: Qmax, Pdet at the Qmax and flow rate at the maximum detrusor pressure may ai to predict subjects who might require De novo CIC after AC for refractory idiopathic OAB.
Objectives: To evaluate the results of using a shorter ileal segment (40 cm only) in reconstructi... more Objectives: To evaluate the results of using a shorter ileal segment (40 cm only) in reconstructing Studer ileal neobladder after radical cystectomy. Subjects and methods: Radical cystectomy and modified Studer ileal neobladder was performed in 60 patients for invasive bladder cancer. Only 40 cm of the ileum was used; 32 cm segment for constructing the body of the neobladder, while the remaining 8 cm as an isoperistaltic intact limb for ureteral reimplantation. After one year, evaluation included clinical, laboratory, radiographic and urodynamic studies to determine the functional and oncological outcomes. Results: Early complications occurred in 5 patients (8.6%). According to the modified Clavien system, two patients had grade I complications, IIIb occurred in one patient and two patients had grade V complications. Late complications (8.6%) included incisional hernia in 2 patients, deep venous thrombosis, bilateral ureteroileal anastomotic stricture and intestinal obstruction each occurred in one patient. At one year, daytime and nighttime continence was 93.1% and 89.7%, respectively. Reflux was observed in 6 patients (10.3%) which was unilateral in 3 patients and bilateral in 3 without affecting the renal functions. Neobladder pressure was 7-18 cmH 2 O at half capacity and 13-38 cmH 2 O at full capacity with no uninhibited contractions. Conclusion: Minimizing the length of the ileum for Studer neobladder reconstruction is feasible and with acceptable results.
African Journal of Urology, 2020
Background: Giant hydronephrosis is rare with a controversy about the complete loss of renal func... more Background: Giant hydronephrosis is rare with a controversy about the complete loss of renal functions. Our objective is to present our center's experience with the management of cases of clinically visible giant hydronephrosis considering the potential residual functions. Our study is a retrospective case series of clinically visible giant hydrone-phrosis which was managed during the period July 2001-June 2016. Demographic and clinical variables were studied with specific considerations to the potential residual functions. Results: Of more than 82,000 urological interventions, only 47 cases (0.057%) were operated upon for clinically visible giant hydronephrosis. Group 1 included 21 patients (mean age = 50.43 ± 13.71 years) who were treated initially by nephrostomy tube, and group 2 included 26 patients (mean age = 42.96 ± 15.16 years) who were treated primarily by nephrectomy. The main clinical presentation was abdominal distention (61.7%), while 13 patients (27.7%) were unaware of the swellings. The commonest underlying causes of hydronephrosis were urolithiasis (68.1%) and bilharzial ureteral strictures (23.4%). The contralateral kidney was diseased in 22 cases (46.8%) including the bilateral clinically visible hydronephrosis in 7 cases (15%). Indications of placement of a nephrostomy tube included uremia, infections, and evaluation of renal functions, where 5 cases of group 1 regained significant split function ranged 14-33%. Conclusions: Clinically visible giant hydronephrosis is an extreme form of renal dilatation with different etiologies such as urolithiasis and bilharziasis. Initial placement of a nephrostomy tube may save significant residual functions in these kidneys.
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Papers by Ahmed Mohamed Moeen