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Hammouda HM, Shahat AA, Safwat AS, Taha TM. The long-term consequences of the hypospadias salvage repair issue. BMC Pediatr 2024; 24:58. [PMID: 38243172 PMCID: PMC10797878 DOI: 10.1186/s12887-024-04534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024] Open
Abstract
PURPOSE To present the long-term results of redo-hypospadias at our tertiary referral center following a failed prior repair. METHODS One hundred sixty-four individuals with a history of unsuccessful repairs qualified for our retrospective cohort study. Our inclusion criteria were as follows: pre-operative data that was accessible, redo-hypospadias that was successfully repaired, and at least three years of follow-up at the last hospital visit. RESULTS The mean patient age was 91.3 ± 21.1 months. The mean follow-up after successful repair was 41.3 ± 3.1 months. Ninety-two (group A) had one prior repair, and 72 (group B) had 2 or 3 repairs. Group A underwent six primary techniques: 32 underwent Onlay Island Flap (OIF), 10 underwent Mathieu, 12 underwent Tubularized Incised Plate Urethroplasty (TIPU), 8 underwent Urethral Mobilization (UM), and 34 underwent Buccal Mucosal Graft (BMG) { dorsal inlay Graft Urethroplasty (DIGU) in 4 and staged BMG in 30 patients}. In group B, four procedures were used: TIPU in 4, UM in 6, and BMG in 62 (staged BMG in 50 cases and DIGU in 12). CONCLUSIONS The selected type of repair will depend on many factors, like residual healthy local skin and expertise. Safe techniques for repair of redo hypospadias after its 1st failure include TIPU, Mathieu, UM, OIF, and DIGU for distal varieties. After 2nd or 3rd repair DIGU, UM, and TIPU can be performed in distal types, while staged BMG can be applied for proximal ones.
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Affiliation(s)
- Hisham M Hammouda
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt.
| | - Ahmed A Shahat
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt
| | - Taha M Taha
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt
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Hammouda HM, Shahat AA, Oyoun NA, Safwat AS, Elderwy AA, Elgammal MA. Long term evaluation of continence after complete primary bladder exstrophy repair. J Pediatr Urol 2023; 19:696.e1-696.e6. [PMID: 37607850 DOI: 10.1016/j.jpurol.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Continence after bladder exstrophy (BE) repair remains a major debatable challenge to pediatric urologists, together with the lack of standard definitions and long-term results in large series. OBJECTIVE We assessed the long-term urinary continence in 142 toilet-trained cases after one (1-) stage of complete primary repair of bladder exstrophy (CPRE) and consequent procedures to achieve this goal in a single tertiary referral center. STUDY DESIGN The current retrospective study included 123 boys and 19 girls with BE that were repaired by (1-) stage CPRE. The Mean age at (BE) repair was 9.5 ± 2.6 weeks. Complete penile disassembly (CPD) was used for epispadias repair in 42 (34.1%) and modified Cantwell-Ransley repair (MCR) was used in 81 (65.9%) boys. Bilateral anterior transverse innominate osteotomies (ATIO) were applied in all. Urinary continence was expressed in terms of the dry interval (DI). Continence procedures were afforded if CPRE failed to achieve DI ≥ 3 h (hrs.), those were in the form of endoscopic bladder neck injection (BNI), bladder neck reconstruction (BNR), and bladder neck closure (BNC) with catheterizable stoma. RESULTS The mean age at follow up was 12.1 ± 5.2 years. DI ≥ 3 h was gained in 23 (16.2%) after CPRE alone, while complementary post-CPRE continence procedures were required to reach this goal in the remaining patients. Deflux injection was reported in 10 (7%), CIC in 8 (5.6%), BNR in 32 (22.5), and BNC with catheterizable stoma alone in 37 (26.1%), or with Charleston pouch in 32 (22.5%). DISCUSSION We think that ≥3 h DI with voiding represents an appropriate definition of continence after BE repair. According to the results in the current series, we think that successful anatomical closure of BE is achievable, but the functional outcome in terms of continence and its evaluation is tricky. Results of continence were reported to change with age of the child, and it is difficult to evaluate both before toilet training age and long-term follow up. CONCLUSIONS Long-term follow up of CPRE with bilateral ATIO alone or with BNI results in ≥3 h DI in a few cases; BNR after CPRE can provide a good chance for continence; otherwise, BNC with catheterizable stoma is a valid option.
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Affiliation(s)
- Hisham M Hammouda
- Urology Department Pediatric Urology Division, Assiut University, Assiut, Egypt.
| | - Ahmed A Shahat
- Urology Department Pediatric Urology Division, Assiut University, Assiut, Egypt
| | - Nariman Abol Oyoun
- Urology Department Pediatric Orthopedic Division, Orthopedic and Traumatology Department, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Urology Department Pediatric Urology Division, Assiut University, Assiut, Egypt
| | - Ahmed A Elderwy
- Urology Department Pediatric Urology Division, Assiut University, Assiut, Egypt
| | - Mohamed A Elgammal
- Urology Department Pediatric Urology Division, Assiut University, Assiut, Egypt
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Shahat AA, Kamel AA, Taha TM, Abonnoor AEI, Reda A, Faddan AA, Elderwy AA, Safwat AS, Kurkar A, Abdelkawi IF. A randomized trial comparing transurethral to percutaneous cystolithotripsy in boys. BJU Int 2022; 130:254-261. [DOI: 10.1111/bju.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmed A. Shahat
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Ahmed A. Kamel
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Taha M. Taha
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | | | - Ahmed Reda
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Amr A. Faddan
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Ahmad A. Elderwy
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Ahmed S. Safwat
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Adel Kurkar
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Islam F. Abdelkawi
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
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Mahran A, Baaklini G, Hassani D, Abolella HA, Safwat AS, Neudecker M, Hijaz AK, Mahajan ST, Siegel SW, El-Nashar SA. Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature. Int Urogynecol J 2019; 30:1023-1035. [PMID: 30874835 DOI: 10.1007/s00192-019-03898-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/05/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP. METHODS A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS). RESULTS Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) -4.34, 95% confidence interval (CI) = -5.22, to-3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD -4.32, CI 95% = -5.32, to -3.31 (p < 0.001) for the standard approach, compared with WMD -4.63, 95% CI = -6.57 to -2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD -4.13, CI 95% -5.36 to -2.90 versus without (WMD -5.72, CI 95% = -6.18, to-5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01). CONCLUSIONS SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.
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Affiliation(s)
- Amr Mahran
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Urology, Assiut University, Assiut, Egypt
| | - Gina Baaklini
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daisy Hassani
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | | | | | - Mandy Neudecker
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adonis K Hijaz
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA
| | | | - Sherif A El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop MAC 5034, Cleveland, OH, 44106, USA. .,Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
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Safwat AS, Hasanain A, Shahat A, AbdelRazek M, Orabi H, Abdul Hamid SK, Nafee A, Bakkar S, Sayed M. Cholecalciferol for the prophylaxis against recurrent urinary tract infection among patients with benign prostatic hyperplasia: a randomized, comparative study. World J Urol 2018; 37:1347-1352. [PMID: 30361957 DOI: 10.1007/s00345-018-2536-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/17/2018] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To explore the role of cholecalciferol for the prophylaxis against recurrent urinary tract infection (UTI) in patients with benign prostatic hyperplasia (BPH). METHODS Our randomized, uncontrolled prospective study included 389 naïve BPH patients with moderate/severe symptoms, consecutively. The patients were randomly allocated to two groups; group-A included 193 patients who received tamsulosin, while group-B included another 196 patients who received tamsulosin with cholecalciferol. The study population was followed up for 2 years after the start of the treatment. For all the patients enrolled, clinical evaluation, imaging studies (abdominal and trans-rectal ultrasonography), and laboratory investigations [including urinalysis, urine culture with antibiotic susceptibility testing for positive cultures and estimation of prostate-specific antigen (PSA) level] were provided. RESULTS The incidence rate of recurrent UTI was 9% among the study population; it was significantly higher among group-A patients compared to those of group-B (13.5% vs. 4.6%, p 0.003, OR 2.7, 95% CI 1.5-4.3). Compared to patients of group-A, those of group-B developed a significantly lower level of PSA at the end of treatment period (0.16 ± 0.03 ng/mL vs. 0.27 ± 0.08 ng/mL, p 0.043, OR 1.9, 95% CI 1.2-6.8). CONCLUSIONS Adjuvant cholecalciferol supplementation may be protective against recurrent UTI among patients with BPH receiving tamsulosin therapy without extra adverse effects.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology and Nephrology Hospital, Assiut University, Assiut, 71516, Egypt.
| | - Ahmad Hasanain
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Ahmed Shahat
- Department of Urology and Nephrology Hospital, Assiut University, Assiut, 71516, Egypt
| | | | - Hazem Orabi
- Department of Urology and Nephrology Hospital, Assiut University, Assiut, 71516, Egypt
| | | | - Amany Nafee
- Department of Microbiology and Immunology, Assiut University, Assiut, Egypt
| | - Sally Bakkar
- Department of Biochemistry, Assiut University, Assiut, Egypt
| | - Mohamed Sayed
- Department of Urology and Nephrology Hospital, Assiut University, Assiut, 71516, Egypt
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Safwat AS. Editorial Comment from Dr Safwat to Risk of urinary stones among women with pelvic organ prolapse: A national population-based cohort study. Int J Urol 2018; 25:838. [DOI: 10.1111/iju.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmed S Safwat
- Assiut Urology and Nephrology Hospital; Assiut University; Assiut Egypt
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Safwat AS, Hasanain AF, Mahran A, Bakkar S, Abdel-Aal S, Nafee A. Erectile dysfunction among patients with chronic brucellosis. Int J Impot Res 2018; 30:230-236. [PMID: 30154453 DOI: 10.1038/s41443-018-0068-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Only a single study investigated erectile dysfunction (ED) among patients with chronic brucellosis without including a control group. Our study objective was to determine the prevalence of ED among patients with chronic brucellosis compared to normal subjects, and to explore the predictors of ED. MATERIALS AND METHODS We included 93 chronic brucellosis patients and 92 subjects as a control, from June 2013 to August 2017. Chronic brucellosis was diagnosed based on persistent symptoms for ≥1 year with positive immunoglobulin G antibody titer (≥1:160) by standard tube agglutination test; the mean duration was 21 ± 6.2 months. Clinical evaluation (including an Arabic validated version of the five-item International Index of Erectile Function to diagnose ED; score of 5-21 was diagnostic), imaging studies (including scrotal ultrasonography) and laboratory investigations (including estimation of fasting serum level of glucose (after fasting for 8 h), lipids profile (after fasting for 14 h), and serum level of testosterone) were conducted. A fasting serum glucose level of ≥ 7 mmol/L defined diabetes mellitus (DM). Predictors of ED were identified using multivariate analysis (binary logistic regression). RESULTS The mean age of patients was 35.4 ± 13.7 years; 24.7% of them had DM, while low serum level of testosterone was detected among 54.8%. Among the patients, ED was significantly more frequent compared to the control subjects (69.9% vs. 19.6%, p < 0.001). Low serum level of testosterone (OR 4.8, 95% CI 1.7-29.3, p 0.008), and DM (OR 3.5, 95% CI 1.2-34.6, p 0.011) were the predictors of ED among the patients. CONCLUSIONS The prevalence of ED among patients with chronic brucellosis is high. Low serum level of testosterone and DM are associated with ED among such patients.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology, Assiut University, Assiut, Egypt.
| | - Ahmad F Hasanain
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Ali Mahran
- Department of Dermatology and Andrology (Andrology Unit), Assiut University, Assiut, Egypt
| | - Sally Bakkar
- Department of Biochemisrty, Assiut University, Assiut, Egypt
| | - Sherif Abdel-Aal
- Department of Diagnostic Radiology, Assiut University, Assiut, Egypt
| | - Amany Nafee
- Department of Microbiology and Immunology, Assiut University, Assiut, Egypt
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Moeen AM, Safwat AS, Gadelmoula MM, Moeen SM, Behnsawy HM, Shahat AA, Gadelkareem RA, Hameed DA, Hammouda HM. Does the site of the orthotopic neobladder outlet matter? A prospective randomized comparative study. Eur J Surg Oncol 2018; 44:847-852. [PMID: 29429598 DOI: 10.1016/j.ejso.2018.01.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution. METHODS From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis. RESULTS There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571). CONCLUSION The "non-hole" technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed "hole" technique.
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Affiliation(s)
- Ahmed M Moeen
- Department of Urology, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Department of Urology, Assiut University, Assiut, Egypt.
| | | | - Seham M Moeen
- Department of Anesthesiology and Intensive Care, Assiut University, Assiut, Egypt
| | | | | | | | - Diaa A Hameed
- Department of Urology, Assiut University, Assiut, Egypt
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Gadelkareem RA, Shahat AA, Abdelhafez MF, Moeen AM, Ibrahim AS, Safwat AS. Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children. Urol Int 2018; 101:85-90. [PMID: 29874665 DOI: 10.1159/000488398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The study aimed to present our center's experience with long-standing urethral stones in male children with normal urethra. MATERIALS AND METHODS Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 - June 2016. Demographic and clinical data were studied. RESULTS Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. CONCLUSIONS Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach.
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Affiliation(s)
- Rabea A Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Shahat
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed F Abdelhafez
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Moeen
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrady S Ibrahim
- Department of Anesthesia and Intensive Care, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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Shahat A, Safwat AS, Elderwy A, Abdelkawi IF, Abonnoor AEI, Abdelhafez MF, Moeen A, Hammouda H. Is Concealed Epispadias a Rare Variant? Urology 2017; 109:165-170. [PMID: 28712888 DOI: 10.1016/j.urology.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ahmed Shahat
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
| | - Ahmad Elderwy
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Islam F Abdelkawi
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | | | | | - Ahmed Moeen
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Hisham Hammouda
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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Abstract
OBJECTIVE The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.
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Affiliation(s)
- Ahmed M Moeen
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Ahmed S Safwat
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Ahmad A Elderwy
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Hosny M Behnsawy
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Mahmoud M Osman
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Diaa A Hameed
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
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Safwat AS. Editorial Comment to Two-year-old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy. Int J Urol 2017; 24:329. [PMID: 28295683 DOI: 10.1111/iju.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed S Safwat
- Pediatric Urology Unit, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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Shahat A, Elderwy A, Safwat AS, Abdelkawi IF, Reda A, Abdelsalam Y, Sayed M, Hammouda H. Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study. J Urol 2016; 195:1284-8. [PMID: 26926538 DOI: 10.1016/j.juro.2015.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones. MATERIALS AND METHODS A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation. RESULTS Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649). CONCLUSIONS Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones.
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Affiliation(s)
- Ahmed Shahat
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmad Elderwy
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
| | - Islam F Abdelkawi
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed Reda
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Yasser Abdelsalam
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Mohamed Sayed
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Hisham Hammouda
- Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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Kurkar A, Abulsorour SM, Gamal RM, Eltaher AM, Safwat AS, Gadelmoula MM, Elderwy AA, Shalaby MM, Ghandour AM. Treatment of premature ejaculation: a new combined approach. Egypt Rheumatol Rehabil 2015. [DOI: 10.4103/1110-161x.155649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Kurkar A, Elderwy AA, Abulsorour S, Awad SM, Safwat AS, Altaher A. A randomized, double-blind, placebo-controlled, crossover trial of "on-demand" tramadol for treatment of premature ejaculation. Urol Ann 2015; 7:205-10. [PMID: 25835132 PMCID: PMC4374260 DOI: 10.4103/0974-7796.150481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 11/14/2022] Open
Abstract
Objectives: The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation (PE). Subjects and Methods: During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1 fashion to receive different sequences of the three medications: placebo, 50 mg of tramadol and 100 mg of tramadol. Every patient received 10 doses of each medication for 2 months. Intra-vaginal ejaculatory latency time (IELT) was recorded in seconds initially and for each arm. Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported. Results: Of patients enrolled, 125 (69.4%) continued the study. Patients’ age range was 20-55 years with PE complaint of 1 to 10 years duration. Mean IELT was 72 at presentation, 82 for placebo, 150 for tramadol 50 mg, and 272 for tramadol 100 mg (P < 0.001 for all comparisons). PE was successfully treated in only 2.4% of patients with placebo, in contrast to 53.6% and 85.6% with 50 and 100 mg tramadol, respectively (P < 0.001 for all comparisons). On multivariate logistic regression analysis, baseline IELT was the only predictor of successful treatment of PE with both tramadol 50 mg (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03-1.07, P < 0.001) and tramadol 100 mg (OR: 1.07, 95% CI: 1.04-1.11, P < 0.001). Postmicturition dribble annoyed 12.8% of those who received 50 mg tramadol and 33.6% of those who received 100 mg tramadol (P < 0.001). Weak scanty ejaculation was the main complaint in 7.2% versus 21.6% of those using 50 and 100 mg tramadol, respectively (P = 0.002). Two patients discontinued tramadol 100 mg due to side-effects. Conclusion: Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE.
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Affiliation(s)
- Adel Kurkar
- Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt
| | - Ahmad A Elderwy
- Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt
| | | | - Sara M Awad
- Department of Dermatology and Venorology, Assiut University Hospitals, Assiut 71515, Egypt
| | - Ahmed S Safwat
- Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt
| | - Ahmed Altaher
- Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt
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Elgammal MA, Safwat AS, Elderwy A, El-Azab AS, Abdelkader MS, Hammouda HM. Primary versus secondary ureteroscopy for pediatric ureteral stones. J Pediatr Urol 2014; 10:1193-8. [PMID: 25138475 DOI: 10.1016/j.jpurol.2014.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 05/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the outcome of primary versus secondary ureteroscopy for pediatric ureteral stones. PATIENTS AND METHODS A retrospective chart review study that included 66 children aged less than 12 years, who were subdivided into two groups: Group A, which included 42 children who had undergone primary ureteroscopy without pre-stenting; and Group B, which included 24 children who had undergone ureteroscopy after ureteric stenting. Kidneys, ureters and bladder radiographs were done on the first postoperative day to assess the degree of stone clearance and stent position. RESULTS Age, gender, stone location and stone size were not significantly different between both groups. In Group A, 31 (73.8%) children required ureteric dilation, 13 (31%) had a tight ureter that failed to respond to dilation, 25 (59.5%) displayed complete stone clearance, and of these, 13 (52%) needed postoperative stenting. One child experienced ureteric injury during stone disintegration and was stented for two weeks. Children in Group B experienced a 95.8% complete stone clearance rate, with no ureteric injury reported; postoperative stenting was performed in three (12.5%) children.. CONCLUSION Secondary ureteroscopy is preferable over primary ureteroscopy in pediatric populations because of a significantly lower need for ureteric dilation, shorter procedure time and better stone clearance rate..
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Affiliation(s)
| | - A S Safwat
- Department of Urology, Assiut University, Egypt.
| | - A Elderwy
- Department of Urology, Assiut University, Egypt
| | - A S El-Azab
- Department of Urology, Assiut University, Egypt
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Safwat AS, Hameed DA, Elgammal M, Abdelsalam YM, Abolyosr A. Reply by the authors. Urology 2013; 82:1192. [PMID: 24358498 DOI: 10.1016/j.urology.2013.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abdel-Kader MS, Tamam AA, Elderwy AA, Gad M, El-Gamal MA, Kurkar A, Safwat AS. Management of symptomatic ureteral calculi during pregnancy: Experience of 23 cases. Urol Ann 2013; 5:241-4. [PMID: 24311902 PMCID: PMC3835980 DOI: 10.4103/0974-7796.120294] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 12/31/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose: To present our experience in the management of symptomatic ureteral calculi during pregnancy. Materials and Methods: Twenty-three pregnant women, aged between 19 and 28 years presented to the obstetric and urology departments with renal colic (17 cases, 73.9%) and fever and renal pain (6 cases, 26.1%); suggesting ureteric stones. The diagnosis was established by ultrasonography (abdominal and transvaginal). Outpatient follow-up consisted of clinical assessment and abdominal ultrasonography. Follow-up by X-ray of the kidneys, ureter, and bladder (KUB), or intravenous urography (IVU) was done in the postpartum period. Results: Double J (DJ) stent was inserted in six women (26%) with persistent fever followed by extracorporeal shock wave lithotripsy (ESWL) one month post-partum. Ureteroscopic procedure and pneumatic lithotripsy were performed for 17 women (distal ureteric stone in 10, middle ureter in 5, and upper ureteric stone in 2). Stone-free rate was 100%. No urologic, anesthetic, or obstetric complications were encountered. Conclusions: Ureteroscopy, pneumatic lithotripsy, and DJ insertion could be a definitive and safe option for the treatment of obstructive ureteric stones during pregnancy.
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Abstract
OBJECTIVE To report our 8-year follow up for redo hypospadias repair. METHODS A total of 56 patients with previous failed hypospadias repair were included in our study. Patients' data were analyzed regarding age, number of previous repairs, meatal location, procedure performed, operative time and complications. Patients were followed up for 3 to 102 (mean 52) months. RESULTS Patient age ranged from 15 to 204 (mean 90.7) months. Forty-two patients had a single previous hypospadias repair, eleven had two previous repairs and three had four previous repairs. Of the 56 patients, 16 underwent oral mucosal graft urethroplasty, 15 onlay island flap, 14 parameatal flap, 10 tubularized incised plate urethroplasty, and 1 tubularized preputial flap. Complications were encountered in 16 (28.5%) patients in the form of graft contracture in 3, meatal stenosis in 2, urethral stricture in 2 including the patient with tubularized flap, urethra-cutaneous fistula in 7, bleeding in 1 and skin disruption in 1. The final complication rate was 25%. CONCLUSIONS Decision making in redo hypospadias surgery depends mainly on local tissue availability and the degree of tissue scarring. The characteristics of oral mucosal graft make it suitable for urethroplasty in the absence of local donor tissues. A long-term follow up for redo hypospadias repair is required to assess the late neourethral stricture and residual penile curvature.
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Affiliation(s)
- Ahmed S Safwat
- Pediatric Urology Section, Urology Department, Assiut University, Egypt.
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Safwat AS, Hammouda HM, Kurkar AA, Bissada NK. Outcome of bilateral laparoscopic Fowler-Stephens orchidopexy for bilateral intra-abdominal testes. Can J Urol 2013; 20:6951-6955. [PMID: 24128837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION To evaluate the outcome of bilateral laparoscopic Fowler-Stephens orchidopexy (BLFSO) for bilateral intra-abdominal testes. MATERIALS AND METHODS Prospectively, all patients with bilateral intra-abdominal testes between 2006 and 2010 were included in this study. Patients' data were analyzed for age, procedure whether single stage or staged Fowler-Stephens, intraoperative and postoperative complications, and follow up results. RESULTS BLFSO was performed in a total of 48 testes in 24 boys with a median age of 31.6 months (range 12 to 150). All procedures were performed on an outpatient basis. Of the 24 boys, six were managed with a single stage BLFSO. The remaining 18 patients were managed with staged Fowler-Stephens orchidopexy. Testicular position after laparoscopy was the mid lower scrotum in 43 testes, the remaining five testes retracted to the inguinal canal in three (required inguinal approach for orchidopexy) and to the neck of scrotum in two. Testicular atrophy was encountered in two testes with a follow up of 18 months postoperatively. CONCLUSIONS Outpatient single stage or staged bilateral laparoscopic Fowler-Stephens orchidopexy were successful in managing boys with bilateral intra-abdominal testes.
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Safwat AS, Hameed DA, Elgammal MA, Abdelsalam YM, Abolyosr A. Percutaneous Suprapubic Stone Extraction for Posterior Urethral Stones in Children: Efficacy and Safety. Urology 2013; 82:448-50. [DOI: 10.1016/j.urology.2013.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/10/2013] [Accepted: 03/12/2013] [Indexed: 11/16/2022]
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Osman MM, Gamal WM, Gadelmoula MM, Safwat AS, Elgammal MA. Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience. ACTA ACUST UNITED AC 2011; 40:403-8. [PMID: 22057206 DOI: 10.1007/s00240-011-0435-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 10/17/2011] [Indexed: 11/26/2022]
Abstract
The management of renal calculi following previous open surgery represents a challenge for urologists. The aim of this study is to evaluate the outcomes and safety of ureteroscopic laser retrograde intrarenal surgery (RIRS) for renal calculi following prior open renal surgery. The charts of 53 patients who underwent RIRS for renal calculi following prior open surgery for urolithiasis were reviewed. Both flexible and semi-rigid ureteroscopes were utilized together with holmium: YAG laser for stone disintegration. Intravenous urography, computed tomography (CT) and ultrasound were used to evaluate the patient, perioperatively. Stone size ranged from 5 to 32 mm (mean 14.3 mm). The mean operative time was 86 min (20-130). The overall stone-free rate was 92.4%. The overall stone-free rates after one and two-procedures were 79.2% (42 cases) and 92.4% (49 cases), respectively. Four patients (7.5%) had larger residual fragments, 2 (3.8%) of them underwent SWL, and 2 (3.8%) cases were followed up conservatively. Major complications were reported in two patients (3.8%). Stone analysis revealed calcium oxalate in 39 patients, uric acid in 5, calcium phosphate in 4, struvite in 3, and cystine in 2 cases. Ureteroscopic retrograde intrarenal surgery for renal calculi following prior open renal surgery was a minimally invasive, safe procedure with a high success rate. It is a viable alternative for PNL in managing recurrent renal calculi efficiently.
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Affiliation(s)
- Mahmoud M Osman
- Urology Department, Assiut University Hospital, Assiut 71516, Egypt.
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Bissada NK, Safwat AS, Hammouda H. Editorial comment. Urology 2011; 77:1287. [PMID: 21624587 DOI: 10.1016/j.urology.2011.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Safwat AS, Hameed DA, Elgammal MA, Abdel-Salam YM, Abolyosr A. OUTCOME OF PERCUTANEOUS SUPRAPUBIC STONE EXTRACTION FOR PEDIATRIC URETHRAL STONES. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Safwat AS, Bissada NK, Miedema ML. OUTCOME OF BILATERAL LAPAROSCOPIC FOWLER-STEPHENS ORCHIOPEXY FOR BILATERAL INTRA-ABDOMINAL TESTES. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Safwat AS, Bissada NK, Kumar U, Taha MI, Abdel-Hafez SES, Eltaher AM, Abdalla M. Experience with ureteroscopic holmium laser lithotripsy in children. Pediatr Surg Int 2008; 24:579-81. [PMID: 18365216 DOI: 10.1007/s00383-008-2119-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2008] [Indexed: 11/29/2022]
Abstract
The purpose of the study was to evaluate the outcome of ureteroscopic holmium laser lithotripsy (UHLL) in children, taking into consideration different stone locations. Records of 15 children with ureteral calculi managed with UHLL were reviewed. All patients were evaluated with history, clinical, radiological and laboratory assessment prior to treatment. All patients were managed on an outpatient basis. After stone disintegration, if sizable fragments remained, they were retrieved using grasping forceps or stone basket extraction. Patient records were reviewed for age, sex, stone laterality, location, number and size, need for ureteral dilation, stenting and residual fragment extraction. Of the 15 children, 11 were female and 4 were male. Mean age was 8.5 years (age range 2-15 years). There was no significant difference in stone laterality (eight left and seven right ureteral stones). Main presenting symptoms were renal colic, hematuria and urinary tract infection or a combination of these symptoms. The 15 children harbored 15 ureteral stones (range 5-11 mm, mean 7.8 mm) and underwent 15 UHLL procedures. Ureteral dilation was performed in 14 patients using balloon dilators. Stone retrieval was done in all patients. DJ stents were placed at the conclusion of the procedure in 11 patients. Complete stone clearance was achieved at the end of the procedure in all patients (success rate 100%). No complications were encountered during or after the procedure. This study confirms the effectiveness and safety of ureteroscopy and holmium laser in the treatment of ureteral stones in children regardless of stone location.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA
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Safwat AS, Bissada NK, Abdallah MA. ROLE OF URETHRAL ULTRASOUND IN THE EVALUATION OF ANTERIOR URETHRAL STRICTURES. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE The purpose of the study was to identify the spectrum of disease characteristics of pheochromocytoma in children. METHODS Records of 21 consecutive children diagnosed with pheochromocytoma were reviewed. Patients' age, sex, presentation, associated conditions, diagnostic and imaging modalities used, preoperative preparation, operative details, outcome, and follow-up were recorded. RESULTS The study included 21 children. Patients were diagnosed clinically and confirmed by biochemical tests. Tumors were localized by imaging studies and all were confirmed pathologically. Patients included 17 with adrenal and 4 with extra-adrenal tumors including 1 in the urinary bladder. Seventeen had sporadic and 4 had familial pheochromocytoma. Associated manifestations were the predominant features in 1 of the 4 patients with familial pheochromocytoma. The patient with bladder pheochromocytoma presented with gross hematuria. Hypertension and visual disturbances were prominent findings in the other patients with sporadic form. Two patients (1 sporadic and 1 familial) had malignant pheochromocytoma. One patient with benign pheochromocytoma had multiple recurrences in chromaffin-containing sites. All patients were treated surgically. Seventeen patients were treated preoperatively with alpha-adrenergic blockade. Two patients continued to have significant visual disturbances. One patient with malignant pheochromocytoma died of the disease, and 1 with recurrent pheochromocytoma had neurologic consequences. CONCLUSIONS Pheochromocytoma in children has unique characteristics. To our knowledge, this series is one of the largest reports of adrenal pheochromocytoma in children. It also reflects the spectrum of pheochromocytoma in this age group.
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Affiliation(s)
- Nabil K Bissada
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA.
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Safwat AS, Bissada NK. Pheochromocytoma of the urinary bladder. Can J Urol 2007; 14:3757-3760. [PMID: 18163929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Pheochromocytoma of the urinary bladder is rare. Herein, we report our experience with pheochromocytoma of the urinary bladder in three patients. MATERIALS AND METHODS Records of three consecutive patients diagnosed with bladder pheochromocytoma were reviewed. Patients' age, sex, presentation, associated conditions, diagnostic and imaging modalities utilized, management and follow up were recorded. RESULTS The three patients included one child and two adults. An 11-year-old female presented with hematuria and bladder mass. Transurethral biopsy was non-diagnostic and she underwent partial cystectomy with eventual diagnosis of pheochromocytoma. Of the two adults, one was a 35-year-old female with history of gestational tumor who was being followed with computed tomography (CT) scan. A bladder mass was incidentally discovered. Transurethral resection of bladder tumor revealed pheochromocytoma and she underwent partial cystectomy. In retrospect, she has had symptoms related to micturition. The third patient is a 32-year-old male, who presented with fainting on voiding which suggested pheochromocytoma. He was also managed with partial cystectomy. There were no perioperative complications in any of the three patients. CONCLUSIONS Pheochromocytoma of the urinary bladder has unique characteristics. A high index of suspicion should be present in patients who present with suggestive symptoms associated with voiding. In this series, all patients were successfully managed with partial cystectomy.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205-7199, USA
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Safwat AS, Bissada NK, Kumar U, Taha MI, Elanany FG, Eltaher AM, Abdalla MA. Ureteroscopic holmium laser lithotripsy in patients with renal impairment. Int Urol Nephrol 2007; 40:15-7. [PMID: 17680339 DOI: 10.1007/s11255-007-9250-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 06/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria. PATIENTS AND METHODS Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1-7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure. RESULTS All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%. CONCLUSIONS A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham St.-Slot 540, Little Rock, AR 72205-7199, USA
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Fahmy W, Safwat AS, Bissada NK, Curry N, Guirguis N, Clarke HS, Fraig M, Finkbeiner A. Multiple/bilateral renal tumors in patients with Birt–Hogg–Dubé syndrome. Int Urol Nephrol 2007; 39:995-9. [PMID: 17211573 DOI: 10.1007/s11255-006-9129-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 10/02/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our findings in four patients with multiple/bilateral renal cell carcinoma (RCC) and Birt-Hogg-Dubé (BHD) syndrome. PATIENTS AND METHODS A series of four patients with BHD syndrome and RCC is analyzed. Patient charts were reviewed for age, sex, presentation, various clinical manifestations, imaging, management and outcome. RESULTS Patients included 2 males and 2 females. Age ranged from 40 to 65 years (mean 56 years). The interval between the diagnosis of skin lesions characteristic of the disease and the development of renal tumors ranged between 1 and 35 years. Three of the patients had bilateral renal tumors (2 synchronous and one metachronous), one patient had multiple renal tumors in one kidney. In one patient the renal mass was diagnosed with a screening CT scan of the abdomen after the diagnosis of BHD syndrome. One patient had associated spontaneous pneumothorax and thyroid tumor. Only one of the 4 patients had prior family history of BHD syndrome. Renal tumors were clear cell type in 3 patients, and chromophobe tumor in one. Tumor size ranged from 2 to 9 cm. CONCLUSION BHD syndrome is associated with multiple diseases and tumors. We describe four patients with BHD syndrome with multiple or bilateral RCC. Two of the patients were asymptomatic. A high index of suspicion should be present in patients who present with the characteristic skin lesions of BHD syndrome and screening for the presence of renal tumors should be done in those patients. Long term follow up is necessary after treating renal tumors in these patients.
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Safwat AS, Bissada NK. Subtotal urethral duplication. Can J Urol 2006; 13:3275-6. [PMID: 17076950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Urethral duplication is considered a rare congenital anomaly. The exact embryology is still controversial. A patient with subtotal urethral duplication is presented and the technique utilized to excise the anomalous structure is detailed.
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Affiliation(s)
- Ahmed S Safwat
- Department of Urology, University of Arkansas College of Medicine, Arkansas Children's Hospital, Little Rock, Arkansas 72205-7199, USA
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Bissada NK, Safwat AS, Pritchard C, Jackson RR, Sakati N, El-Zawahry AM. 783: Clinical Spectrum of Pheochromocytoma in Children. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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