Papers by Waleed Alkhudair
_______________________________________________________________________________________ Introduct... more _______________________________________________________________________________________ Introduction: The purpose of this video is to demonstrate the use of the robot to perform a transmesocolonic pyelolithotomy of a horseshoe kidney. Materials and Methods: A 35-year old female presented with vague abdominal pain. CT scan imaging revealed the presence of a left horseshoe kidney with multiple pelvicalyceal stones. The patient was positioned in the supine position. A total of 4 ports were introduced. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. First, the dilated renal pelvis was identified behind the thin mesocolon. The mesocolon was entered and renal pelvis was dissected completely from the surrounding fat. Then, the renal pelvis was opened after adequate dissection and stones were visualized inside the calyces. By Prograsp forceps, stones were removed from all the calyces under vision and were extracted from the assistant trocar. Finally, the pylotomy incision was closed using 4 0 Maxon in a continuous fashion and the mesocolon was closed using 3 0 PDS interrupted sutures. A JP drain was placed. Result: Operative time was forty-five minutes, blood loss was 100 ml. The patient was discharged after 48 hours with no immediate complications. Conclusion: The utilization of minimal invasive surgery using the robot to extract multiple pelvicalyceal stones from a horseshoe kidney without reflecting the mesocolon proved to be a feasible and novel way in the management of complex stone disease improving the outcome with minimal morbidity.
Purpose: We evaluate the results of treatment of erectile dysfunction in kidney transplant patien... more Purpose: We evaluate the results of treatment of erectile dysfunction in kidney transplant patients with intracavernosal self-injection of vasoactive drugs. Materials and Methods: We evaluated and treated 26 male kidney transplant patients for erectile dysfunction. All patients had stable kidney function 6 to 75 months (mean 26.6 2 9) aRer transplantation. Each patient received an intracavernosal injection of 20 pg. prostaglandin El (PGEl), and after 20 to 30 minutes the response was assessed. Nonresponders received 40 pg. PGEl at another visit, and those who showed no response were reinjected with 40 pg. PGEl plus 30 mg. papaverine hydrochloride. A total of 21 patients were enrolled in a self-injection program and have been followed between 3 and 21 months (mean 11.6 2 2.7). Results: Hormonal alterations were seen in 7 patients with serum testosterone as low as 16.6 ng./ml. (normal 33 to 1001, and testosterone injections gave only marginal response in 2. Intracavernosal injection o...
Objectives: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital ... more Objectives: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital in Saudi Arabia. Methods: We retrospectively reviewed consecutive cases of patients undergoing RPN at King Faisal
Introduction: The purpose of this study was to determine the prevalence of erectile dysfunction (... more Introduction: The purpose of this study was to determine the prevalence of erectile dysfunction (ED) at our institution in the postrenal transplant population and to compare those patients who had ED with those who did not have ED, with respect to several patient characteristics. Methods: We conducted a cross-sectional study of male renal transplant recipients who were in attendance at the transplant clinic from April 1, 2004, to March 31, 2006. Erectile function was evaluated using the International Index of Erectile Function short form questionnaire. Patients were also screened for depression using the Beck Depression Inventory. We performed a chart review to obtain various patient characteristics. Results: This study involved 55 patients. Their average age was 50 years old and the mean duration of the current transplant was 7.9 years. ED was identified in 28 of the patients (51%). More patients with ED were over age 50 years (64% v. 26%, p = 0.004). There was a higher prevalence ...
European Urology Supplements, 2015
The Journal of Sexual Medicine
Saudi Medical Journal
Objectives: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital ... more Objectives: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital in Saudi Arabia. Methods: We retrospectively reviewed consecutive cases of patients undergoing RPN at King Faisal
Journal of kidney cancer and VHL, 2017
Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or ev... more Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or even mortality due to its unique characteristics and the complications subsequent to its treatment. The classic tumor variant is composed of smooth muscular, vascular, and fatty components. The most straightforward diagnosis is when the fat component is abundant and gives a characteristic appearance on different imaging studies. In fat-poor lesions, however, the diagnosis is difficult and presumed a renal cell carcinoma. Yet, some variants of RAML, though rare, express an aggressive behavior leading to metastasis and mortality. The challenge lies in the early detection of benign variants and identifying aggressive lesions for proper management. Another challenge is when the vascular tissue component predominates and poses a risk of hemorrhage that may extend to the retroperitoneum in a massive life-threatening condition. The predicament here is to identify the characteristics of tumors at ...
Robotic Surgery: Research and Reviews, 2016
Renal artery pseudoaneurysm is an uncommonly recognized complication following partial nephrectom... more Renal artery pseudoaneurysm is an uncommonly recognized complication following partial nephrectomy. It is more common with trauma and percutaneous renal intervention. Furthermore, it is rarely reported with minimally invasive laparoscopic partial nephrectomy. Herein, we report the first case to our knowledge of renal artery pseudoaneurysm following a robotic-assisted partial nephrectomy.
J Urol, 1998
Purpose: We evaluate the results of treatment of erectile dysfunction in kidney transplant patien... more Purpose: We evaluate the results of treatment of erectile dysfunction in kidney transplant patients with intracavernosal self-injection of vasoactive drugs. Materials and Methods: We evaluated and treated 26 male kidney transplant patients for erectile dysfunction. All patients had stable kidney function 6 to 75 months (mean 26.6 2 9) aRer transplantation. Each patient received an intracavernosal injection of 20 pg. prostaglandin E l (PGEl), and after 20 to 30 minutes the response was assessed. Nonresponders received 40 pg. P G E l at another visit, and those who showed no response were reinjected with 40 pg. PGEl plus 30 mg. papaverine hydrochloride. A total of 21 patients were enrolled in a self-injection program and have been followed between 3 and 21 months (mean 11.6 2 2.7). Results: Hormonal alterations were seen in 7 patients with serum testosterone as low as 16.6 ng./ml. (normal 33 to 1001, and testosterone injections gave only marginal response in 2. Intracavernosal injection of 20 pg. PGEl provided good response in 15 patients (57.7%), while 40 Fg. P G E l alone or in combination with 30 mg. papaverine resulted in good response in another 6 and 2 patients, respectively. Among the 21 patients who were enrolled in the self-injection program 19 (90.5%) reported complete satisfaction with no adverse local or systemic complications except for local pain at the injection site in 4. There has been no change in serum creatinine, cyclosporine level or doses of immunosuppression medications during the observation period. Conclusions: Intracavernosal self-injection of PGEl is well accepted and tolerated by kidney transplant patients. It poses no apparent risks to the transplanted kidney and could be a good modality to treat erectile dysfunction in kidney transplant recipients.
Saudi Journal of Kidney Diseases and Transplantation, 2009
Renal transplantation has evolved as the best treatment option for patients with end-stage renal ... more Renal transplantation has evolved as the best treatment option for patients with end-stage renal disease. Different oral problems arise in these patients, either as a direct consequence of drug-induced immunosuppression or pharmacokinetics. To determine the prevalence of intra-oral lesions in a group of medically stable Saudi renal transplant patients (RTP) and to identify possible risk factors, in comparison with age and sex-matched healthy control subjects (HCS), we studied 58 RTP and 52 HCS. All subjects had a thorough oral examination and oral lesions were diagnosed according to the clinically accepted criteria. Gingival overgrowth (GO), erythematous candidiasis (EC) and hairy leukoplakia (HL) were diagnosed in RTP with prevalence of 74.1%, 15.5%, and 8.6%, respectively. The severity of the gingival overgrowth significantly correlated with the use of cyclosporine and nifedipine combination therapy, serum cyclosporine, and serum creatinine level. In conclusions, the finding of our study strongly propose that RTP should undergo routine and regular comprehensive oral examination, and any suspicious lesion must be investigate and treated.
International braz j urol, 2015
_______________________________________________________________________________________ Introduct... more _______________________________________________________________________________________ Introduction: The purpose of this video is to demonstrate the use of the robot to perform a transmesocolonic pyelolithotomy of a horseshoe kidney. Materials and Methods: A 35-year old female presented with vague abdominal pain. CT scan imaging revealed the presence of a left horseshoe kidney with multiple pelvicalyceal stones. The patient was positioned in the supine position. A total of 4 ports were introduced. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. First, the dilated renal pelvis was identified behind the thin mesocolon. The mesocolon was entered and renal pelvis was dissected completely from the surrounding fat. Then, the renal pelvis was opened after adequate dissection and stones were visualized inside the calyces. By Prograsp forceps, stones were removed from all the calyces under vision and were extracted from the assistant trocar. Finally, the pylotomy incision was closed using 4 0 Maxon in a continuous fashion and the mesocolon was closed using 3 0 PDS interrupted sutures. A JP drain was placed. Result: Operative time was forty-five minutes, blood loss was 100 ml. The patient was discharged after 48 hours with no immediate complications. Conclusion: The utilization of minimal invasive surgery using the robot to extract multiple pelvicalyceal stones from a horseshoe kidney without reflecting the mesocolon proved to be a feasible and novel way in the management of complex stone disease improving the outcome with minimal morbidity.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2012
Isolated renal hydatid disease (HD) is rare in non-endemic countries. Clinical and radiological s... more Isolated renal hydatid disease (HD) is rare in non-endemic countries. Clinical and radiological suspicion warrants appropriate serological tests, preoperative treatment and intra-operative precautions. We present a tertiary care centre experience of isolated renal HD in a non-endemic country. We reviewed the medical records of patients with HD treated in the past 20 years. We identified patients with the definitive diagnosis of isolated renal HD and described their management. Of the 119 cases with HD, 6 were found to have isolated renal involvement (5%). Their median age was 46.5 (28-70) years. Five patients presented with flank pain and 1 had an incidentally discovered renal mass. Radiologic investigations raised the suspicion of possible HD in 4 cases, while 2 cases were diagnosed as renal tumours. Computerized tomography showed complex renal cyst in 4, solid renal mass with heterogonous enhancement in 2 and calcification in 5. Eosinophilia and indirect hemagglutination test (IHA...
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2007
The purpose of this study was to determine the prevalence of erectile dysfunction (ED) at our ins... more The purpose of this study was to determine the prevalence of erectile dysfunction (ED) at our institution in the postrenal transplant population and to compare those patients who had ED with those who did not have ED, with respect to several patient characteristics. We conducted a cross-sectional study of male renal transplant recipients who were in attendance at the transplant clinic from April 1, 2004, to March 31, 2006. Erectile function was evaluated using the International Index of Erectile Function short form questionnaire. Patients were also screened for depression using the Beck Depression Inventory. We performed a chart review to obtain various patient characteristics. This study involved 55 patients. Their average age was 50 years old and the mean duration of the current transplant was 7.9 years. ED was identified in 28 of the patients (51%). More patients with ED were over age 50 years (64% v. 26%, p = 0.004). There was a higher prevalence of diabetes mellitus (39% v. 11%...
Transplantation proceedings, 2005
The effect of obesity on renal transplant outcome remains unclear due to conflicting published st... more The effect of obesity on renal transplant outcome remains unclear due to conflicting published studies. The purpose of this study was to assess whether obesity affects the outcome in renal transplant patients. We retrospectively analyzed 33 obese (BMI >30; mean = 34.1 +/- 3.68; group I) and 35 nonobese (BMI < or = 30; mean = 23.6 +/- 3.18; group II) renal transplants performed at our center between March 1999 to December 2002. These two groups were well matched with respect to age, sex, donor source, hypertension, diabetes, ischemic heart disease, hyperlipidemia, native kidney disease (PCKD, 6 vs 4; diabetic, 5 vs 4; glomerulonephritis, 6 vs 7; FSGS, 2 vs 2 and IgA, 2 vs 7), HLA mismatch and immunosuppressants medications (Neoral, 21 vs 25; tacrolimus, 11 vs 10; Cellcept, 28 vs 31; Prednisone, 33 vs 35; ATG, 7 vs 8; Basiliximab, 14 vs 13 and Rapamycin, 5 vs 2, groups I and II, respectively). Follow-up was from 7 months to 4.4 years. Significant differences were noted in operat...
Saudi medical journal, 2002
Angiomyolipoma of the retroperitoneum is extremely rare with only 7 cases reported to date in the... more Angiomyolipoma of the retroperitoneum is extremely rare with only 7 cases reported to date in the literature. Spontaneous hemorrhage and shock is the most common presentation that requires emergency intervention. We report a case of large extrarenal retroperitoneal angiomyolipoma that illustrates a different form of presentation for such a rare tumor mimicking a large locally advanced renal parenchymal tumor. The diagnosis was made by histopathology after performing radical nephrectomy. Although rare, angiomyolipoma of the perinephric fat may have variable presentations and should be considered in the differential diagnosis of large renal tumors particularly in view of possible kidney sparing management.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2012
Lymphangioma of the urinary bladder is a very rare tumour in adulthood. Robotic partial cystectom... more Lymphangioma of the urinary bladder is a very rare tumour in adulthood. Robotic partial cystectomy is evolving for treatment of a limited number of bladder tumours. We describe a case of an adult woman with a bladder dome lymphangioma for which robotic partial cystectomy was carried out.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fah... more Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fahad National Guard Hospital, Riyadh. There were 102 cadaver donor (CAD) and 68 living related donor (LRD) transplants. All patients received triple drug immunosuppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporin until recovery of graft function. The 1,3 and 5 year graft survival was as follows: all transplants 83.5%, 77.6%, 74.7% respectively; LRD transplants, 89.7%, 85.2%, 80.9% respectively; CAD transplants, 81.0%, 72.5%, 70.5% respectively. The commonest cause of graft loss was chronic rejection. The 1,3 and 5 year patient survival was as follows: all transplants, 97.0%, 94.7%, 93.5% respectively; LRD transplants, 98.5%, 97.0%, 95.5% respectively; CAD transplants, 96.0%, 93.0%, 92.0% respectively. The overall results in our center are comparable to those published from other centers in Saudi Arabia and abroad.
Urology Annals, 2013
To report the result of vesicovaginal fistula (VVF) repair using the transabdominal approach with... more To report the result of vesicovaginal fistula (VVF) repair using the transabdominal approach with flap interposition. Materials and Methods: Between January 2004 and the end of 2011, operative reports data and medical records systems were reviewed for all VVF cases operated and followed in Urology Department. All patients had detailed history taking and physical exam followed by intravenous pyelograms or contrast CT abdomen and pelvis to rule out the presence of ureterovaginal fistulae. We utilized the infra-umbilical transabdominal approach and transpose an omental flap or peritoneal flap between the vaginal and bladder incisions in all cases. Results: Twenty-six patients with an average age of 46 years were managed for VVF through transabdominal route with interposition of omental flap or peritoneal flap by a single surgeon. Twelve cases of VVF were secondary to lower segment cesarean section (LSCS) and twelve cases of VVF were secondary to lower segment cesarean section (LSCS) and 14 cases following hysterectomies. We had 16 complex VVF with 4 cases that failed the previous abdominal repair outside the hospital. More than 95% (25) of our patients were cured at the first attempt, with no recurrence at a mean follow-up of 28.6 (range 8-73) months. Conclusion: Successful repair of VVF depends on the experience of the surgeon and adhering to basic surgical principles. Very high success rate was seen when flap interposition had been used.
Uploads
Papers by Waleed Alkhudair