The Egyptian Journal of Hospital Medicine, Apr 1, 2022
Background: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of upper u... more Background: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of upper urinary tract obstruction in the pediatric age group. Surgical repair is indicated in cases with significantly impaired renal drainage or progressive deterioration of renal function. Objective: The aim of the current study was to identify the outcome of pyeloplasty in children with split renal function (SRF) less than 10%. Patients and methods: This observational retrospective analytical study carried out on 28 children ≤ 16 years with split renal function of ipsilateral kidney 10% in the
Türk Üroloji Dergisi/Turkish Journal of Urology, 2022
OBJECTIVE The objective of this study is to evaluate and compare urethral plate tubularization vs... more OBJECTIVE The objective of this study is to evaluate and compare urethral plate tubularization vs Mathieu in circumcised Megameatus intact prepuce (MIP) repair. Many techniques were described for MIP, which account for 5% of hypospadias cases and usually diagnosed at time of, or even after circumcision. MATERIAL AND METHODS Forty-six circumcised MIP cases were prospectively enrolled in this prospective study, which was carried out in April 2017 and March 2020. Patients were randomly allocated into two groups. Group one operated by simple urethral plate tubularization and group two by the Mathieu technique. Hypospadias objective scoring evaluation (HOSE) scores, success rate, operative time, and the need for relaxing incision or scrotal flaps for skin closure were compared. RESULTS Forty-three circumcised cases (22 in group one and 21 in group two) completed at least 6 months of follow-up. Ages ranged from 12 to 39 months (mean 18.06 6 6.35) in group one and from 10 to 32 months (mean 19.5 6 7.14) in group two. There was no significant difference between cases with accepted outcome based on HOSE scores (14) of the two groups (P value ¼ .942). Three fistulae and one meatal stenosis were the complications in group one (18.2%). In group two, two patients complicated with fistula (9.5%) (P value ¼ .674). Significant differences were present only in the operative time (P ¼ .001) and in the need of relaxing incision or scrotal skin flaps (P ¼ .012) both were more in group two. CONCLUSION Mathieu and tubularized incised plate urethroplasty both are good options for circumcised MIP repair.
Objectives To report the safety and efficacy of holmium laser and compare its results with cold k... more Objectives To report the safety and efficacy of holmium laser and compare its results with cold knife visual internal urethrotomy (VIU) in the management of short segment urethral stricture. Methods This prospective randomized study included 66 male patients aged more than 18 years, with short segment bulbar urethral strictures < 2 cm from March 2020 to March 2022. The patients were randomized into two groups each containing 33 patients. In group A (Cold knife group), Sachse cold knife was used for stricture treatment. In group B (Holmium group), internal urethrotomy was done with Ho:YAG laser. Patients were evaluated before the operation and followed up after the operation at 1, 3, 6 and 12 months by physical examination, IPSS, PVR, Qmax and retrograde urethrography. Results There was significant improvement in the mean values of IPSS, PVR and Qmax in both groups. There was no significant difference between both groups in the mean values of IPSS, PVR and Qmax during follow-up vi...
Objectives: To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL)... more Objectives: To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL) in flankfree modified supine (FFMS) and prone positions in management of pediatric renal calculi. Patients and Methods: This prospective randomized study included 55 pediatric patients with symptomatic renal stones and suitable for UMPCNL. They were randomized into two groups. Group A included 28 patients who were treated by UMPCNL in FFMS position (with a pad below the ipsilateral shoulder and buttocks, putting ipsilateral upper limb over the chest, and crossing the extended ipsilateral lower limb over the flexed contralateral one) and Group B included 27 patients treated by UMPCNL in the prone position. In both groups dilatation was done to 13F sheath allowing the introduction of 6/7.5F semirigid ureteroscope and fragmentation of stones by Holmium: yttrium-aluminum-garnet laser with a 550-lm fiber laser lithotripter. Results: The operation time in FFMS position UMPCNL group was significantly shorter than prone position UMPCNL group (84.3-9.87 vs 99.3-8.75 minutes) with p = 0.022. There was no significant difference between both groups in terms of stone-free rate (89.3% vs 88.9%), overall complication rate (including transient fever; 21.4% vs 18.5%), postoperative pain (visual analog scale score; 3.4-0.8 vs 3.3-0.9), or hospital stay (3.53-0.8 vs 4.1-1.1 days). Conclusion: Both UMPCNL in FFMs and prone positions are feasible, safe, and effective in treatment of pediatric renal stones with relatively shorter operative time in FFMS position.
INTRODUCTION The measurement of the urethral plate width (as an objective parameter) and its effe... more INTRODUCTION The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width < 8 mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases. OBJECTIVE To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate. STUDY DESIGN Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared. RESULTS 39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications. DISCUSSION Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas et al., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit et al., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively. CONCLUSION Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Objectives: To evaluate the outcome of augmentation of shallow urethral plate by lingual graft in... more Objectives: To evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias. Patients and methods: Between June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1-3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8 mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation. Results: Success rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days. Conclusion: The one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate.
The Egyptian Journal of Hospital Medicine, Apr 1, 2022
Background: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of upper u... more Background: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of upper urinary tract obstruction in the pediatric age group. Surgical repair is indicated in cases with significantly impaired renal drainage or progressive deterioration of renal function. Objective: The aim of the current study was to identify the outcome of pyeloplasty in children with split renal function (SRF) less than 10%. Patients and methods: This observational retrospective analytical study carried out on 28 children ≤ 16 years with split renal function of ipsilateral kidney 10% in the
Türk Üroloji Dergisi/Turkish Journal of Urology, 2022
OBJECTIVE The objective of this study is to evaluate and compare urethral plate tubularization vs... more OBJECTIVE The objective of this study is to evaluate and compare urethral plate tubularization vs Mathieu in circumcised Megameatus intact prepuce (MIP) repair. Many techniques were described for MIP, which account for 5% of hypospadias cases and usually diagnosed at time of, or even after circumcision. MATERIAL AND METHODS Forty-six circumcised MIP cases were prospectively enrolled in this prospective study, which was carried out in April 2017 and March 2020. Patients were randomly allocated into two groups. Group one operated by simple urethral plate tubularization and group two by the Mathieu technique. Hypospadias objective scoring evaluation (HOSE) scores, success rate, operative time, and the need for relaxing incision or scrotal flaps for skin closure were compared. RESULTS Forty-three circumcised cases (22 in group one and 21 in group two) completed at least 6 months of follow-up. Ages ranged from 12 to 39 months (mean 18.06 6 6.35) in group one and from 10 to 32 months (mean 19.5 6 7.14) in group two. There was no significant difference between cases with accepted outcome based on HOSE scores (14) of the two groups (P value ¼ .942). Three fistulae and one meatal stenosis were the complications in group one (18.2%). In group two, two patients complicated with fistula (9.5%) (P value ¼ .674). Significant differences were present only in the operative time (P ¼ .001) and in the need of relaxing incision or scrotal skin flaps (P ¼ .012) both were more in group two. CONCLUSION Mathieu and tubularized incised plate urethroplasty both are good options for circumcised MIP repair.
Objectives To report the safety and efficacy of holmium laser and compare its results with cold k... more Objectives To report the safety and efficacy of holmium laser and compare its results with cold knife visual internal urethrotomy (VIU) in the management of short segment urethral stricture. Methods This prospective randomized study included 66 male patients aged more than 18 years, with short segment bulbar urethral strictures < 2 cm from March 2020 to March 2022. The patients were randomized into two groups each containing 33 patients. In group A (Cold knife group), Sachse cold knife was used for stricture treatment. In group B (Holmium group), internal urethrotomy was done with Ho:YAG laser. Patients were evaluated before the operation and followed up after the operation at 1, 3, 6 and 12 months by physical examination, IPSS, PVR, Qmax and retrograde urethrography. Results There was significant improvement in the mean values of IPSS, PVR and Qmax in both groups. There was no significant difference between both groups in the mean values of IPSS, PVR and Qmax during follow-up vi...
Objectives: To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL)... more Objectives: To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL) in flankfree modified supine (FFMS) and prone positions in management of pediatric renal calculi. Patients and Methods: This prospective randomized study included 55 pediatric patients with symptomatic renal stones and suitable for UMPCNL. They were randomized into two groups. Group A included 28 patients who were treated by UMPCNL in FFMS position (with a pad below the ipsilateral shoulder and buttocks, putting ipsilateral upper limb over the chest, and crossing the extended ipsilateral lower limb over the flexed contralateral one) and Group B included 27 patients treated by UMPCNL in the prone position. In both groups dilatation was done to 13F sheath allowing the introduction of 6/7.5F semirigid ureteroscope and fragmentation of stones by Holmium: yttrium-aluminum-garnet laser with a 550-lm fiber laser lithotripter. Results: The operation time in FFMS position UMPCNL group was significantly shorter than prone position UMPCNL group (84.3-9.87 vs 99.3-8.75 minutes) with p = 0.022. There was no significant difference between both groups in terms of stone-free rate (89.3% vs 88.9%), overall complication rate (including transient fever; 21.4% vs 18.5%), postoperative pain (visual analog scale score; 3.4-0.8 vs 3.3-0.9), or hospital stay (3.53-0.8 vs 4.1-1.1 days). Conclusion: Both UMPCNL in FFMs and prone positions are feasible, safe, and effective in treatment of pediatric renal stones with relatively shorter operative time in FFMS position.
INTRODUCTION The measurement of the urethral plate width (as an objective parameter) and its effe... more INTRODUCTION The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width < 8 mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases. OBJECTIVE To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate. STUDY DESIGN Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared. RESULTS 39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications. DISCUSSION Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas et al., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit et al., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively. CONCLUSION Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Objectives: To evaluate the outcome of augmentation of shallow urethral plate by lingual graft in... more Objectives: To evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias. Patients and methods: Between June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1-3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8 mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation. Results: Success rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days. Conclusion: The one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate.
INTRODUCTION AND OBJECTIVES: Posterior urethral valve (PUV) is the most common cause of bladder o... more INTRODUCTION AND OBJECTIVES: Posterior urethral valve (PUV) is the most common cause of bladder outlet obstruction in male children. Limited data about bladder neck incision (BNI) in children with PUV are available. The aim of this study is to evaluate the role of BNI in PUV patients with high bladder neck (BN).
Uploads
Papers by ahmed sakr