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Elmansy H. Editorial comment on "Reevaluating 'Top-Down' HoLEP: the case for anterior fibromuscular stroma as a surgical landmark". Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00842-y. [PMID: 38678159 DOI: 10.1038/s41391-024-00842-y] [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: 11/22/2023] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.
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Chakraborty A, Elterman DS, Corsi N, Bouhadana D, Bailly G, Patel P, McLellan R, Hickey L, Costa D, Andrews M, Evans H, Forbes CM, Elmansy H, Meskawi M, Bhojani N, Chugtai B, Zorn KC. An analysis of benign prostatic hyperplasia surgical treatment reimbursement trends across Canada: Examining provincial changes over the recent decade with comparison to cost of living changes. Can Urol Assoc J 2024; 18:cuaj.8638. [PMID: 38587981 DOI: 10.5489/cuaj.8638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examines trends in surgeon compensation for these treatments within Canada. METHODS The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examining first, the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. RESULTS Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. CONCLUSIONS The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.
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Affiliation(s)
- Anindyo Chakraborty
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC; Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nicholas Corsi
- Wayne State University School of Medicine, Detroit, MI, United States
| | - David Bouhadana
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Gregory Bailly
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Rowen McLellan
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Liam Hickey
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Daniel Costa
- Division of Urology, Queen Elizabeth Hospital, Charlottetown, PEI, Canada
| | - Matthew Andrews
- Division of Urology, Memorial University, St. John's, NL, Canada
| | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Connor M Forbes
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Bilal Chugtai
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Kevin C Zorn
- Department of Urology, Université de Montréal, Montreal, QC, Canada
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MacDonald A, Fathy M, Nikoufar P, Hodhod A, Hadi RA, Alhelal S, Alaradi H, Zakaria AS, Shahrour W, Elmansy H. Efficacy of GreenLight laser prostatectomy in urinary retention. Can Urol Assoc J 2024; 18:E120-E126. [PMID: 38381943 PMCID: PMC11034970 DOI: 10.5489/cuaj.8556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The objective of our study was to evaluate the efficacy and durability of GreenLight laser prostatectomy for the management of acute urinary retention (AUR) and chronic urinary retention (CUR) and to determine outcomes compared to patients without preoperative urinary retention (UR). METHODS We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy at our institution from May 2018 to July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or GreenLight laser prostatectomy. CUR was defined as PVR >300 mL in males able to void and initial catheter drainage >1000 mL in males unable to void in the absence of pain. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. RESULTS One hundred sixty-eight males who underwent GreenLight laser prostatectomy were included in our study. The UR group consisted of 88 patients (50 AUR and 38 CUR), and the lower urinary tract symptoms (LUTS) group was comprised of 80 individuals. There were no statistically significant differences between the AUR and CUR subgroups regarding demographics. The UR group had a significantly higher age and a significantly higher postoperative catheterization time compared to the LUTS cohort. The CUR subgroup had a significantly higher PVR at one, three, and six months compared to the AUR subgroup, although other outcome measures were similar between the two cohorts. During three- and six-month followup visits, the UR group had a significantly higher PVR than the LUTS cohort. At 12 months postoperative, the LUTS group had a higher catheter-free rate than the UR group (p=0.001). The successful first trial of void (TOV) rate for the UR and LUTS groups were 83% and 80%, respectively. At 12-month followup, the catheter-free rate for the UR and LUTS cohorts was 87.5% and 100%, respectively. CONCLUSIONS GreenLight laser prostatectomy is an effective and durable treatment for UR, with a high catheter-free rate and comparable outcomes when performed to manage LUTS.
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Affiliation(s)
- Anastasia MacDonald
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Moustafa Fathy
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- Department of Urology, Menoufia Faculty of Medicine, Menoufia, Egypt
| | - Parsa Nikoufar
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amr Hodhod
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ruba Abdul Hadi
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Saud Alhelal
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Husain Alaradi
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed S. Zakaria
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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MacDonald A, Fathy M, Nikoufar P, Hodhod A, Hadi RA, Vangala SK, Bassuony M, Zakaria AS, Shahrour W, Elmansy H. Safety and clinical outcomes of GreenLight laser prostatectomy in octogenarians. Can Urol Assoc J 2024; 18:E65-E72. [PMID: 38010222 PMCID: PMC10954284 DOI: 10.5489/cuaj.8482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION We evaluated the impact of age on perioperative morbidity and clinical outcomes in patients undergoing GreenLight laser prostatectomy for benign prostatic hyperplasia (BPH). METHODS We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy from May 2018 to July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure and American Society of Anesthesiology (ASA) scores. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS ), quality of life (QoL) assessment, maximum urinary flow rate (Qmax), postvoid residual volume (PVR), and catheter-free status. RESULTS One-hundred-sixty-eight males who underwent GreenLight laser prostatectomy were included. The non-octogenarian group consisted of 111 patients and the octogenarian group comprised 57 individuals. Based on ASA scores, most octogenarians were deemed high-risk (ASA III: 91.2%), while over half of non-octogenarians were lower-risk (ASA II: 53.2%) (p<0.001). Intraoperative parameters, including operative time, vaporization time, lasing time, and energy did not differ significantly between groups. There was no difference in the proportion of intraoperative complications between non-octogenarians and octogenarians (0.9% vs. 3.5%). Postoperative complications were not statistically significant between the two groups (p=0.608). There was also no observed difference in the proportion of patients requiring readmission (p=0.226) or retreatment (p=1.0). CONCLUSIONS GreenLight laser prostatectomy is a safe and effective treatment for BPH regardless of age. It provides similar surgical and functional outcomes as younger men while maintaining the QoL of octogenarians.
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Affiliation(s)
- Anastasia MacDonald
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Moustafa Fathy
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- Department of Urology, Menoufia Faculty of Medicine, Menoufia, Egypt
| | - Parsa Nikoufar
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amr Hodhod
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ruba Abdul Hadi
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Sai K. Vangala
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Mohammed Bassuony
- Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed S. Zakaria
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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Ismail A, Mehrnoush V, Alaref A, Rozenberg R, Elmansy H, Shahrour W, Burute N, Shuster A, Prowse O, Zakaria A, Shabana W, Kotb A. Endophytic to total tumour volume ratio: An added variable to patients with T1b/T2 renal tumours undergoing partial nephrectomy. Arch Ital Urol Androl 2023; 95:11723. [PMID: 37990980 DOI: 10.4081/aiua.2023.11723] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Partial nephrectomy is the standard of care to patients with small renal masses. It is still encouraged to larger tumours whenever feasible. The aim of this study is to look for the endophytic to total tumour volume ratio as an added variable to study the complexity of partial nephrectomy to patients with T1b/ T2 renal tumours. METHODS Retrospective data collection of patients that had partial nephrectomy for T1b/T2 renal tumours by a single surgeon was done. Radiological re-assessment for the CT images to measure the endophytic to total tumour volume ratio was done. RESULTS The mean age of the patients was 63 years. The study included 25 males and 11 females. All cases were managed by open surgery using retroperitoneal transverse lateral lumbotomy and warm ischemia was used in all patients. The mean tumour volume was 74 cc, the mean endophytic tumour volume was 29 cc. The mean percentage of endophytic to total tumour volume was 42%. CONCLUSIONS Partial nephrectomy is safe for most of the patients with good performance status, having large renal masses. More complex surgery can be predicted in patients with endophytic to total tumour volume greater than 42%.
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Affiliation(s)
- Asmaa Ismail
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Vahid Mehrnoush
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Amer Alaref
- Radiology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Radu Rozenberg
- Radiology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Hazem Elmansy
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Walid Shahrour
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Nishigandha Burute
- Radiology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Anatoly Shuster
- Radiology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Owen Prowse
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Ahmed Zakaria
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Walid Shabana
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
| | - Ahmed Kotb
- Urology Department, TBRHSC, Northern Ontario School of Medicine University, Thunder Bay, ON.
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Elmansy H, Abbas L, Fathy M, Hodhod A, Shabana W, Alkandari A, Habib E, Meshref A, Roshdy MA, Shahrour W. Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00730-x. [PMID: 37783838 DOI: 10.1038/s41391-023-00730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. METHODS One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. RESULTS There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) (p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. CONCLUSIONS The HoLEP procedure significantly improves patients' urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
| | - Loay Abbas
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Moustafa Fathy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amr Hodhod
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Waleed Shabana
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Abdulrahman Alkandari
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Enmar Habib
- Urology Department, Cairo University, Cairo, Egypt
| | - Alaa Meshref
- Urology Department, Cairo University, Cairo, Egypt
| | - Mamdouh A Roshdy
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Walid Shahrour
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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Nikoufar P, Hodhod A, Fathy M, Zakaria AS, Shabana W, Abdul Hadi R, Abdelkawi IF, Alaradi H, Abbas L, Alaref A, Shahrour W, Elmansy H. Thulium Fiber Laser vs Pulse-Modulated Holmium MOSES Laser in Flexible Ureteroscopy for the Management of Kidney Stones: A Single-Center Retrospective Analysis. J Endourol 2023; 37:1081-1087. [PMID: 37597211 DOI: 10.1089/end.2023.0284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Introduction and Objective: The study's primary objective was to compare the laser efficiency and clinical outcomes of two widely used systems, the holmium MOSES laser and the thulium fiber laser (TFL), in managing kidney stones. The secondary outcomes were to evaluate the impact of stone composition on laser efficacy. Methods: We conducted a retrospective review of patients who underwent flexible ureteroscopy (f-URS) for solitary renal calculi between December 2020 and August 2022 at our institution and had a 3-month postoperative CT scan. Patient demographics and stone parameters were recorded, including stone site, size, volume, and density. Intraoperative data were collected and analyzed, including total operative time, ureteroscopy time, lasing time, technique, total energy delivered, and stone composition. All patients underwent a CT scan at 3 months follow-up. We recorded the presence of residual stones and the percentage of stone volume reduction. Ablation efficiency was calculated by dividing the energy utilized (J) by the stone volume (mm3). The ablation speed was calculated by dividing the stone volume (mm3) by the lasing time (seconds). Patients with a stone size <4 mm were deemed stone-free. Results: The MOSES and TFL groups comprised 62 and 49 patients, respectively. There were no significant differences between groups for baseline patient demographics or stone characteristics. The two modalities had comparable total energy, laser time, efficacy, and ablation speeds. No differences were detected in stone-free rates or complications between both groups. When dealing with calcium phosphate stones, we observed that the lasing time was significantly shorter with MOSES than TFL (7.95 vs 10.85 minutes, respectively [p = 0.01]). Conclusions: MOSES and TFL laser systems had comparable efficacy for lithotripsy of renal calculi during f-URS; however, calcium phosphate stones had a longer lasing time with TFL. REB Number: 100210.
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Affiliation(s)
- Parsa Nikoufar
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
- Urology Department, Menoufia University, Shebin Elkom, Egypt
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Waleed Shabana
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Islam F Abdelkawi
- Urology Department, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Husain Alaradi
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Amer Alaref
- Radiology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
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Mehrnoush V, Darsareh F, Kotb A, Zakaria AS, Elmansy H, Shabana W, Shahrour W. Timing of Urinary Catheter Removal After Urethroplasty: A Systematic Review. Urology 2023; 176:1-6. [PMID: 36963670 DOI: 10.1016/j.urology.2023.03.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To synthesize existing evidence to evaluate the outcomes of different urinary catheter removal timing (early vs late) after urethroplasty. METHODS We performed a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science from inception to August 7, 2022. Articles were initially screened by title, abstract, and subsequently by a full paper review before being included in the final analysis. All comparative studies that assessed the association between urethral catheterization duration and frequency of extravasation and recurrence rate in patients who underwent urethroplasty were included in the analysis. Exclusion criteria were case reports, case series, letters to editors, and non-English studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS Of the 439 relevant records in the literature databases, 5 studies involving 634 patients were included. In all 5 studies, the extravasation rate was not significantly different between the early and late catheter removal groups. Among the 3 studies that reported recurrence rates, the recurrence rate was low, with no statistically significant difference between the early and late catheter removal groups. Wound and urinary tract infections were among the most common complications, with a higher rate in patients with late catheter removal. CONCLUSION Early catheter removal following urethroplasty does not increase the rate of extravasation or recurrence during long-term follow-up. The existing evidence can serve as the foundation for additional research with a larger sample size.
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Affiliation(s)
- Vahid Mehrnoush
- Urology Department, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Fatemeh Darsareh
- Fertility and Infertility Research Centre, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Waleed Shabana
- Urology Department, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada.
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Elmansy H, Zakaria AS, Hodhod A, Shabana W, Ahmad A, Oquendo F, Fathy M, Abbas L, Abdul Hadi R, Kelly R, Kotb A, Shahrour W. Holmium Laser Xpeeda Vaporization vs GreenLight XPS Vaporization of the Prostate for Benign Prostatic Obstruction: 1-Year Results from a Randomized Controlled Clinical Study. J Endourol 2023; 37:706-712. [PMID: 37029802 DOI: 10.1089/end.2022.0727] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Introduction and Objective: To compare the safety and efficacy of Holmium Laser Xpeeda Vaporization and GreenLight XPS Vaporization of the prostate in patients with prostate size ≤80 g. Methods: Ninety-two men with benign prostatic hyperplasia (BPH) and prostate size ≤80 g scheduled for laser prostatectomy were included in this prospective randomized trial. Outcome measures were collected and compared, including International Prostate Symptom Score (IPSS), quality of life (QoL), flow rate, postvoid residual urine volume (PVR), International Index of Erectile Dysfunction (IIEF)-15, prostate-specific antigen (PSA), transrectal ultrasound prostate volume, and catheterization time. Perioperative complications were also recorded. Patients were offered a trial of void (TOV) 3 hours after their procedures. All patients were followed-up at 1, 3, 6, and 12 months. Results: There were no significant differences in preoperative baseline data between the two surgical groups. Operative parameters and postoperative outcomes were comparable. Effective same-day TOV was noted in 73.1% and 72.7% of the Xpeeda and GreenLight XPS patients, respectively (p = 0.98). All patients were discharged home within 24 hours of their surgeries. The laser energy and postoperative complications were significantly lower in the Xpeeda group (p = 0.002 and p = 0.026, respectively). At 3 months, the PSA levels significantly dropped in both groups (p = 0.002 and p < 0.001). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. Conclusions: Holmium Laser Xpeeda Vaporization and GreenLight XPS Vaporization are safe and effective in the treatment of BPH. Same-day discharge with early TOV is a feasible option. Clinical Trials.gov Identifier: NCT04386941.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Waleed Shabana
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Abdulrahman Ahmad
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Fabiola Oquendo
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
- Urology Department, Menoufia University, Shebin Elkom, Egypt
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ryan Kelly
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
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MacDonald A, Mehrnoush V, Ismail A, Di Matteo L, Zakaria A, Shabana W, Shaban A, Bassuony M, Elmansy H, Shahrour W, Prowse O, Kotb A. History of infantile BCG immunization did not predict lamina propria invasion and/or high-grade in patients with non-muscle invasive bladder cancer. Arch Ital Urol Androl 2023:11380. [PMID: 37259815 DOI: 10.4081/aiua.2023.11380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To evaluate the utility of infantile BCG vaccination history in predicting stage and grade of tumours in non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS We retrospectively analyzed data from patients from a single center who were diagnosed with new NMIBC and underwent transurethral resection of bladder tumour (TURBT) between 2017 and 2022. We assessed BCG immunization status with various demographics and comorbidities, as well as tumour recurrence, progression, stage, and grade. RESULTS A total of 188 patients met the inclusion criteria for our study. The mean age of patients at the time of diagnosis was significantly lower in those that had been immunized with BCG (71 ± 9) than those who had not (77 ± 10) (p < 0.0001). History of BCG immunization did not correlate with sex, history of diabetes mellitus (DM), prior history of intravesical BCG treatment, and tumour recurrence, progression, stage, and grade. CONCLUSIONS History of infantile BCG vaccination did not correlate with the depth of invasion and/or the grade in patients with non-muscle invasive bladder cancer. Patients that received infantile BCG vaccination were significantly younger at the time of diagnosis of NMIBC.
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Affiliation(s)
| | | | - Asmaa Ismail
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Livio Di Matteo
- Department of Economics, Lakehead University, Thunder Bay, ON.
| | - Ahmed Zakaria
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | | | - Ashraf Shaban
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | | | - Hazem Elmansy
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | | | - Owen Prowse
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Ahmed Kotb
- Northern Ontario School of Medicine, Thunder Bay, ON.
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Sanaye C, Mehrnoush V, Ismail A, Prowse O, Zakaria A, Elmansy H, Shahrour W, Kotb A. Case - Late abdominal wall recurrence following open nephroureterectomy for urothelial carcinoma. Can Urol Assoc J 2023; 17:E90-E91. [PMID: 36473474 PMCID: PMC10027353 DOI: 10.5489/cuaj.8006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Upper tract urothelial carcinoma (UTUC) recurrence following open nephroureterectomy to the surgical wound is very uncommon. Herein, we describe a case with late abdominal wall recurrence, surgically removed, with no evidence of further recurrence over a short period of followup.
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Affiliation(s)
| | - Vahid Mehrnoush
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Asmaa Ismail
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Owen Prowse
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Zakaria
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Kotb
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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12
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Elmansy H, Hodhod A, Fathy M, Violette PD, Elshafei A, Zakaria AS, Kelly R, Rozenberg R, Alaref A, Abbas L, Abdul Hadi R, Kotb A, Shahrour W. Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience. World J Urol 2023; 41:805-811. [PMID: 36708378 DOI: 10.1007/s00345-023-04292-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Refractory hematuria secondary to prostatic disease typically resolves with conservative management; however, this condition may require hospitalization with extensive measures to control life-threatening bleeding. The aim of this study was to report our experience using holmium laser enucleation of the prostate (HoLEP) as an emergency treatment in this clinical setting. METHODS We conducted a retrospective review of all patients that presented to the emergency department with refractory hematuria of prostatic origin from October 2017 to September 2021, for whom hospitalization and conservative management failed to control bleeding. All emergency HoLEP procedures were performed by a single surgeon. Preoperative and intraoperative parameters, as well as perioperative outcomes, were collected and analyzed. Postoperative outcomes included duration of foley catheterization, length of postoperative hospital stay, and hospital readmissions. RESULTS A total of 40 emergency HoLEP procedures were performed. Our cohort had a median prostate volume of 110.5 cc and a median resected weight of 81 g. Twenty-seven patients (67.5%) were on anticoagulant or antiplatelet medications on admission. The urethral catheter was removed within 1 day in 95% of patients with a successful trial of void (TOV). Moreover, 92.5% of patients were discharged home within 24 h of their procedure. Two patients (5%) experienced clot retention within one-week post-discharge with a 2.5% overall readmission rate. All postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual volume (PVR), showed significant improvement at 1 year follow up. CONCLUSION Our experience demonstrates that emergency HoLEP is an effective treatment option for patients with refractory hematuria of prostatic origin. Further studies are warranted to consolidate our results.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada.
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada.,Urology Department, Menoufia University, Shebin Elkom, Egypt
| | - Philippe D Violette
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ahmed Elshafei
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ryan Kelly
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Radu Rozenberg
- Radiology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amer Alaref
- Radiology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
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Noureldin Y, Gupta A, Hodhod A, Zakaria AS, Hadi RA, Mehrnoush V, Abbas L, Fathy M, Alaref A, Kotb A, Shahrour W, Elmansy H. Same-day trial of void and discharge following standard vs. MOSES TM holmium laser enucleation of the prostate: A single-center experience. Can Urol Assoc J 2023; 17:E23-E28. [PMID: 36121886 PMCID: PMC9872824 DOI: 10.5489/cuaj.7983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION We aimed to compare perioperative and postoperative outcomes and to assess the safety and feasibility of same-day trial of void (TOV) in patients who underwent standard holmium laser enucleation of the prostate (HoLEP) vs. MOSESTM HoLEP (MoLEP). METHODS We conducted a retrospective review of prospectively collected data of patients that underwent HoLEP (100 W) or MoLEP (120 W) with same-day catheter removal three hours postoperatively at our institution from August 2018 to September 2021. Patient demographics, intraoperative parameters, and postoperative outcomes were analyzed. Data were compared as means with standard deviation and medians with interquartile range (IQR) or numbers and percentages. Continuous and categorical variables were assessed using the Mann-Whitney U test and Chi-squared test, respectively. Predictors of shorter enucleation time and failed same-day TOV were investigated. RESULTS Of the 90 patients included, 28 underwent HoLEP while 62 had MoLEP. There was no significant difference between the groups in terms of the successful TOV (23 [82%] vs. 58 [93.5%], p=0.1) and readmission rate (3 [10.7%] vs. 1 [1.6%], p=0.08); however, the MoLEP group had a significantly shorter mean enucleation time (p<0.001), mean hemostasis time (p<0.001), mean morcellation time (p=0.003), and lower mean energy used (p<0.001). On the logistic regression model, MoLEP (odds ratio [OR] 0.03, 95% confidence interval [CI] 0.007-0.19, p<0.001), lower preoperative prostate-specific antigen (PSA) test (OR 1.25, 95% CI 1.01-1.55, p=0.03), and smaller prostate size (OR 1.06, 95% CI 1.02-1.09, p<0.001) were independent predictors of shorter enucleation time. History of preoperative retention was the only significant factor associated with a failed same-day TOV (p=0.04). There was no difference in intraoperative or postoperative complication rates or postoperative functional outcomes between the two technologies. CONCLUSIONS Same-day TOV and discharge are feasible following standard HoLEP and MoLEP, with comparable outcomes; however, the use of MOSESTM technology offered better enucleation efficiency with excellent hemostatic potential. Preoperative retention was the only predictor of failed same-day TOV.
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Affiliation(s)
- Yasser Noureldin
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Aurinjoy Gupta
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amr Hodhod
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed S. Zakaria
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ruba Abdul Hadi
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Vahid Mehrnoush
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Loay Abbas
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Moustafa Fathy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada,Department of Urology, Menoufia University, Shebin Elkom, Egypt
| | - Amer Alaref
- Department of Radiology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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Mahmoud AA, Sadaka EA, Abouegylah M, Amin SA, Elmansy H, Asal MF, Köksal MA, Gawish A. Impact of breath-hold technique on incidence of cardiac events in adjuvant left breast cancer irradiation. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04551-8. [PMID: 36585984 DOI: 10.1007/s00432-022-04551-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study aims to compare the incidence of cardiac events and to identify its predictors in left breast cancer patients receiving adjuvant radiotherapy using breath-hold technique (DIBH) versus free breathing technique (FB). METHODS We conducted a retrospective multi-center study of two arms; the free breathing arm included 208 patients who were treated with traditional radiotherapy treatment technique, while DIBH arm included 224 patients who were treated with breath-hold technique using The Varian Real-time Position Management (RPM). We retrospectively reviewed the medical records of the patients from January 2010 to December 2017. RESULTS The mean dose to the heart and left anterior descending artery were significantly lower in the DIBH arm (2.10 ± 0.39 and 6.16 ± 0.18 Gy) compared with (4.29 ± 0.60 Gy and 12.69 ± 0.93 Gy, respectively) in the FB arm. The incidence of cardiac events was higher in the FB arm than in the DIBH arm, but it was not statically significant. Our analysis revealed that age, diabetes, hypertension, smoking, mean LAD dose, and heart mean dose were significant prognostic factors for the occurrence of cardiac events in the breath-hold arm. Hypertension, smoking, as well as heart mean dose were independent risk factors for the occurrence of cardiac events. CONCLUSION Use of the DIBH technique resulted in a significant reduction in doses to the heart, LAD and lesser cardiac events incidence compared to free breathing.
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Affiliation(s)
- Amr A Mahmoud
- Department of Clinical Oncology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Emad A Sadaka
- Department of Clinical Oncology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed Abouegylah
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sara A Amin
- Department of Clinical Oncology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Hazem Elmansy
- Department of Cancer Management and Research, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohamed F Asal
- Department of Surgical Oncology, General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mümtaz A Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Ahmed Gawish
- Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Mehrnoush V, Brennan L, Ismail A, Zakaria A, Elmansy H, Shahrour W, Prowse O, Kotb A. Radical cystectomy for bladder urothelial carcinoma with aggressive variant histology. Arch Ital Urol Androl 2022; 94:291-294. [DOI: 10.4081/aiua.2022.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aim of this study is to report our experience in managing bladder cancer in patients with variant pathology. Methods: Retrospective data collection for all patients managed by radical cystectomy over the last 3 years for a variant pathol-ogy was completed. We specifically included micropapillary and nested variants. Results: Ten patients were identified, with eight having micropapillary carcinoma (MPC) and two having nested vari-ants. Nine patients were male. The median age was 75. The two patients with nested variant were 56 and 62 years old, respec-tively, whereas all patients with MPC were over the age of 70. Upon cystectomy of all micropapillary cases, three patients(37.5%) had positive lymph node invasion and the final patholo-gy was T2 (two patients), T3 (two patients), and T4 (four patients). Barring a grade III complication Clavien-Dindo classi-fication due to wound dehiscence that necessitated secondary surgical closure, there were no specific perioperative complica-tions. Given the urethral invasion, cystourethrectomy was per-formed on the female patient. Within a median 13-month fol-low-up, three patients developed local recurrence, including two urethral and one new lateral pelvic mass. Conclusions: Considering the muscle invasive nature of micropapillary and nested bladder cancer, aggressive surgical management should not be postponed. Moreover, due to notable prevalence of concurrent and/or recurrent urethral involvement, initial urethrectomy or early and frequent postoperative ure-throscopy should be provided. Patients with variant histology bladder cancer may benefit from early radical cystectomy when compared to bladder sparing protocols and prostate sparing cystectomy treatment options.
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Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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Elmansy H, Hodhod A, Elshafei A, Noureldin YA, Mehrnoush V, Zakaria AS, Hadi RA, Fathy M, Abbas L, Kotb A, Shahrour W. Comparative analysis of MOSES TM technology versus novel thulium fiber laser (TFL) for transurethral enucleation of the prostate: A single-institutional study. Arch Ital Urol Androl 2022; 94:180-185. [PMID: 35775343 DOI: 10.4081/aiua.2022.2.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Novel laser technologies have been developed for the minimally invasive surgical management of benign prostatic hyperplasia (BPH). The objective of this study was to assess the safety and efficacy of MOSESTM technology versus the thulium fiber laser (TFL) in patients with BPH undergoing transurethral enucleation of the prostate. METHODS We conducted a retrospective review of prospectively collected data of eighty-two patients who underwent transurethral enucleation of the prostate using MOSESTM or TFL technologies from August 2020 to September 2021. Preoperative and intraoperative parameters, in addition to postoperative outcomes, were collected and analyzed. RESULTS Twenty patients underwent transurethral enucleation of the prostate with TFL, while 62 had MOSESTM HoLEP. No statistically significant difference in preoperative characteristics was observed between the groups. Patients in the TFL group had longer median enucleation, hemostasis, and morcellation times (p < 0.001) than those in the MOSESTM cohort. The longer morcellation time of TFL is mostly related to less visibility. The postoperative outcomes IPSS, QoL, Qmax, and post void residual (PVR), were comparable between the groups at 1, 3 and 6 months. The incidence of urge urinary incontinence (p = 0.79), stress urinary incontinence (p = 0.97), and hospital readmission rates (p = 0.1) were comparable between the two groups. CONCLUSIONS A satisfactory safety and efficacy profile with comparable postoperative outcomes was demonstrated for both techniques; though, MOSESTM technology was superior to TFL in terms of shorter overall operative time.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Elshafei
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Yasser A Noureldin
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Urology Department, Benha University, Benha.
| | - Vahid Mehrnoush
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Urology Department, Menoufia University, Shebin Elkom.
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
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Tesolin D, Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Radical cystectomy for clinical T4b urothelial carcinoma: An Ontario, single-center experience. Can Urol Assoc J 2022; 16:E274-E277. [PMID: 34941484 PMCID: PMC9119594 DOI: 10.5489/cuaj.7277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Guidelines surrounding the management of T4b muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC) are limited and lack clarity. Our objective was to analyze our single-center experience to provide additional insight into the role of RC. METHODS We performed a retrospective data analysis using clinical, radiological, and pathological information for all patients managed by RC for cT4b MIBC at the Thunder Bay Regional Health Sciences Centre (July 2015 to July 2020). Patients that had MIBC as their first diagnosis were termed the de novo group and patients that were initially diagnosed as having non-MIBC were termed the progressive group. RESULTS Nineteen consecutive patients (16 males and three females), with a median age of 68 years, managed by two urologists over the last five years, met study criteria. Eleven (58%) of the patients had de novo MIBC while eight (42%) presented with progressive disease. All patients had dysuria as a presenting symptom. Only one (5%) patient received neoadjuvant chemotherapy. There were low rates of perioperative transfusion (11%), bowel resections (5%), postoperative transfusions (0%), ileus (32%), urine leak (16%), and wound dehiscence (5%). Fourteen patients (74%) had positive lymph nodes. All patients had adjuvant chemotherapy. The one-year recurrence rate in these patients was 53%, with 32% of recurrence being distant metastasis. The one-year survival rate was 95%. CONCLUSIONS Patients in the de novo and progressive arms of our cohort had similar rates of surgical complications and disease recurrence. We found operative morbidity and disease control to be reasonable, suggesting RC can be considered more often in the management of T4b MIBC patients.
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Affiliation(s)
- Daniel Tesolin
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Asmaa Ismail
- Urology Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Urology Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Owen Prowse
- Urology Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Ahmed Kotb
- Urology Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
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Thangavelu M, Ismail A, Zakaria A, Elmansy H, Shahrour W, Prowse O, Kotb A. Aristolochic acid: What urologists should know. Arch Ital Urol Androl 2022; 94:123-125. [PMID: 35352538 DOI: 10.4081/aiua.2022.1.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022] Open
Abstract
To the Editor, Aristolochic acid is one of major causes for upper tract urothelial carcinoma, especially in younger population. While it is mentioned as a cause in guidelines, little is actually known about the toxin by urologists. We are aiming in our letter to provide some direct and clear information to ourselves that would help us to know more about that toxin and how it can adversely affect our patients [...].
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Affiliation(s)
| | - Asmaa Ismail
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Zakaria
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Hazem Elmansy
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Walid Shahrour
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Owen Prowse
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Kotb
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
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Mehrnoush V, Keramati S, Ismail A, Shabana W, Zakaria A, Elmansy H, Shahrour W, Prowse O, Kotb A. Adverse pathological outcomes of patients with de novo muscle invasive bladder cancer in Northern Ontario. Arch Ital Urol Androl 2022; 94:41-45. [PMID: 35352519 DOI: 10.4081/aiua.2022.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the clinical and pathological characteristics of patients with de novo muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy in Northern Ontario. METHODS This is a retrospective cross-sectional study of patients with de novo T2 MIBC who underwent radical cystectomy over a 2-year-period in Thunder Bay Regional Health Sciences Centre. Clinical and pathological characteristics of Trans Urethral Resection of Bladder Tumors and cystectomy specimens were analyzed. RESULTS Of the 59 patients aged 67 ± 8.8 years, predominated by males (80%), 27.1% were younger than age 60. After surgery, upstaging was noted in 59.3% (T3 in 27.1% and T4 in 32.2%) while node positive was noted in 36% of patients. Prostate adenocarcinoma was incidentally discovered in 20 (34%) of patients with 50% considered significant (Gleason score ≥ 7). Downstaging was found in those who had neoadjuvant chemotherapy (p = 0.001). CONCLUSIONS The high prevalence of younger ages (less than 60), a high rate of upstaging, the presence of high-grade incidental prostate cancer, and lymph node positives in T2 de novo MIBC in Northern Ontario, warrants further investigation of potential causes and risk factors at individual, public, and population health levels in the region.
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Affiliation(s)
- Vahid Mehrnoush
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Shahrzad Keramati
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Waleed Shabana
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Ahmed Zakaria
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Owen Prowse
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Ontario.
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Shabana W, Kotb A, Tesolin D, Ibrahim MFK, Dolcetti K, Boucher A, Bassuony M, Ramchandar K, Zakaria AS, Elmansy H, Shahrour W. Diagnostic assessment program for prostate cancer: Lessons learned after 2 years and degree of compliance to Canadian guidelines. Arch Ital Urol Androl 2021; 93:389-392. [PMID: 34933523 DOI: 10.4081/aiua.2021.4.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2018, our Institute launched the Diagnostic Assessment Program (DAP) for prostate cancer. It enabled quick access to a urologist for patients presented to family physician with elevated PSA and allowed fast multidisciplinary patient care. We aim to document our data over 2 years in comparison to data before implementation of DAP and its impact on the degree of adherence to Canadian guidelines. METHODS From April 2016 to April 2020, 880 patients who were evaluated for prostate cancer at Thunder Bay Regional Health Sciences Centre (TBRHSC) were included in this study. Patients' characteristics, clinical data, waiting times and line of treatment before and after implementation of DAP were calculated and statistically analysed. RESULTS The median waiting time to urology consultation was significantly reduced from 68 (IQR 27-168) days to 34 (23-44) days (p < 0.001). The time from patient's referral to prostate biopsy decreased substantially from 34 (20-66) days to 18(11- 25) days after DAP (p < 0.001). After DAP, the percentage of Gleason 6 detected prostate cancers were significantly increased (19.7% to 30%) (p = 0.02). After DAP, rate for intermediate-risk patients elected for external beam radiotherapy (from 53.5% to 57.9%, p = 0.53) and radical prostatectomy (from 34.5% to 39.4%, p = 0.47) increased. More compliance to Canadian guidelines was observed in intermediate risk patients (88% vs 97.3%, p =.008). CONCLUSIONS Implementation of DAP has led to a notable reduction of waiting time to urology consult and prostate biopsy. There is significant increase in Gleason 6 detected prostate cancer. Increased compliance to Canadian guidelines was detected in intermediate risk patients.
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Affiliation(s)
- Waleed Shabana
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Kotb
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Daniel Tesolin
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | | | | | - Amy Boucher
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | | | | | | | - Hazem Elmansy
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Walid Shahrour
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Abridged version. Can Urol Assoc J 2021; 15:383-393. [PMID: 34847343 PMCID: PMC8631858 DOI: 10.5489/cuaj.7652] [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: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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23
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Full-text. Can Urol Assoc J 2021; 15:E676-E690. [PMID: 34464257 PMCID: PMC8631842 DOI: 10.5489/cuaj.7581] [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: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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24
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Mehrnoush V, Ismail A, Zakaria A, Elmansy H, Shahrour W, Prowse O, Kotb A. Micropapillary bladder cancer: an added indication to prophylactic urethrectomy. J Surg Case Rep 2021; 2021:rjab501. [PMID: 34804485 PMCID: PMC8598118 DOI: 10.1093/jscr/rjab501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
There is little research on the role of urethrectomy during cystectomy in patients with micropapillary bladder cancer (MPBC). We present two cases of MPBC cystectomy and suggest that urethrectomy be performed concurrently as a preventive measure. The first case involved a woman who had a mixed solid and papillary bladder tumour. An anterior pelvic exenteration was performed as well as a total urethrectomy. The T4a micropapillary variant tumour was confirmed by pathology. The second case involved a man with T1 MPBC who was treated with a BCG induction course. A recurrent muscle-invasive MPBC was discovered during follow-up. During the radical cystoprostatectomy, the urethra was spared. T2 MPBC was discovered through pathology. He had a urethrectomy 6 months later due to urethral bleeding, and the pathology revealed micropapillary cancer of the urethra.
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Affiliation(s)
- Vahid Mehrnoush
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
| | - Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
| | - Ahmed Zakaria
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, TBRHSC, 980 Oliver Road, Thunder Bay, Ontario, P7B 6V4, Canada
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Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Late upper urinary tract urothelial carcinoma following radical cystectomy, presenting as page kidney. Asian J Urol 2021; 8:442-443. [PMID: 34765454 PMCID: PMC8566367 DOI: 10.1016/j.ajur.2021.02.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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26
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Samhouri L, Meheissen MAM, Ibrahimi AKH, Al-Mousa A, Zeineddin M, Elkerm Y, Hassanein ZMA, Ismail AA, Elmansy H, Al-Hanaqta MM, AL-Azzam OA, Elsaid AA, Kittel C, Micke O, Stummer W, Elsayad K, Eich HT. Impact of Adjuvant Radiotherapy in Patients with Central Neurocytoma: A Multicentric International Analysis. Cancers (Basel) 2021; 13:cancers13174308. [PMID: 34503124 PMCID: PMC8430823 DOI: 10.3390/cancers13174308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/05/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Central neurocytoma is a rare tumor accounting for <0.5% of all intracranial tumors. We analyzed 33 patients treated with surgical resection with or without radiotherapy from ten closely cooperating institutions in Germany, Egypt, and Jordan. Patients who received radiotherapy had longer progression-free survival with an acceptable toxicity profile. Abstract Background: Central neurocytoma (CN) is a rare tumor accounting for <0.5% of all intracranial tumors. Surgery ± radiotherapy is the mainstay treatment. This international multicentric study aims to evaluate the outcomes of CNs patients after multimodal therapies and identify predictive factors. Patients and methods: We retrospectively identified 33 patients with CN treated between 2005 and 2019. Treatment characteristics and outcomes were assessed. Results: All patients with CN underwent surgical resection. Radiotherapy was delivered in 19 patients. The median radiation dose was 54 Gy (range, 50–60 Gy). The median follow-up time was 56 months. The 5-year OS and 5-year PFS were 90% and 76%, respectively. Patients who received radiotherapy had a significantly longer PFS than patients without RT (p = 0.004) and a trend towards longer OS. In addition, complete response after treatments was associated with longer PFS (p = 0.07). Conclusions: Using RT seems to be associated with longer survival rates with an acceptable toxicity profile.
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Affiliation(s)
- Laith Samhouri
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
| | - Mohamed A. M. Meheissen
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Ahmad K. H. Ibrahimi
- Department of Radiotherapy and Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan; (A.K.H.I.); (A.A.-M.)
| | - Abdelatif Al-Mousa
- Department of Radiotherapy and Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan; (A.K.H.I.); (A.A.-M.)
| | - Momen Zeineddin
- Department of Pediatrics, King Hussein Cancer Center, Amman 11942, Jordan;
| | - Yasser Elkerm
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
- Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria 21500, Egypt
| | - Zeyad M. A. Hassanein
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Abdelsalam Attia Ismail
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Hazem Elmansy
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
- Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria 21500, Egypt
| | | | - Omar A. AL-Azzam
- Princess Iman Research Center, King Hussein Medical Center, Royal Medical Services, Amman 11942, Jordan;
| | - Amr Abdelaziz Elsaid
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 21500, Egypt; (M.A.M.M.); (Z.M.A.H.); (A.A.I.); (A.A.E.)
- Specialized Universal Network of Oncology (SUN), Alexandria 21500, Egypt; (Y.E.); (H.E.)
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, 33699 Bielefeld, Germany;
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany;
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
- Correspondence: ; Tel.: +490-2518347384
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Münster 48149, Germany; (L.S.); (C.K.); (H.T.E.)
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Elmansy H, Shabana W, Waugh M, Ahmad A, Hadi RA, Shahrour W. Top-down thulium fiber laser enucleation of the prostate: technical aspects. Cent European J Urol 2021; 74:271. [PMID: 34336250 PMCID: PMC8318026 DOI: 10.5173/ceju.2021.0010.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hazem Elmansy
- Northern Ontario School of Medicine, Urology Department, Thunder Bay, Ontario, Canada
| | - Waleed Shabana
- Northern Ontario School of Medicine, Urology Department, Thunder Bay, Ontario, Canada
| | - Miranda Waugh
- Northern Ontario School of Medicine, Urology Department, Thunder Bay, Ontario, Canada
| | - Abdulrahman Ahmad
- Northern Ontario School of Medicine, Urology Department, Thunder Bay, Ontario, Canada
| | - Ruba Abdul Hadi
- Northern Ontario School of Medicine, Urology Department, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Northern Ontario School of Medicine, Urology Department, Thunder Bay, Ontario, Canada
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28
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Elmansy H, Shabana W, Rozenberg R, Ahmad A, Kotb A, Al Aref A, Shahrour W. Pulsed fluoroscopy in retrograde urethrograms. Arch Ital Urol Androl 2021; 93:241-243. [PMID: 34286564 DOI: 10.4081/aiua.2021.2.241] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Retrograde urethrogram (RUG) is one of the corner stones for the reconstructive urologist. With hundreds of RUGs being performed yearly in busy reconstructive center, the concern for radiation exposure to the patient and the medical personnel becomes important. We propose the use of pulsed fluoroscopy to decrease the radiation exposure for patient and medical personnel. METHODS Patients presenting to our center with urethral strictures between March 2016 and March 2019 were included in our study. The fluoroscopy machine was set for pulsed fluoroscopy at a setting of 4 pulses per second. Patient information including demographics, pre-operative diagnosis, Intra-op findings, and fluoroscopy time were recorded. RUG was performed to localize the stricture pre-operatively and post-operatively. RESULTS A total of 185 RUG were performed between March 2016 and March 2019. The median age was 63 (14-81). The remaining 154 RUG had 77 performed pre-operatively and 77 performed post-operatively. Pathology was identified in 77 patients. Intra-operative confirmation of pre-operative finding was found in 76 patients (98.7%). Median fluoroscopy time was found to be 2.43 seconds (0.5 sec- 6.5 sec). CONCLUSIONS Pulsed fluoroscopy reduces the radiation exposure in RUG without a reduction in the diagnostic capacity of the test. Reduction of fluoroscopy can have beneficial cumulative effect as per the ALARA principle for patients and medical personnel. Further studies with randomized control trials could be of great benefit.
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Affiliation(s)
- Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Waleed Shabana
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Radu Rozenberg
- Department of Radiology, Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Abdulrahman Ahmad
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Amer Al Aref
- Department of Radiology, Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON.
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Shabana W, Oquendo F, Hodhod A, Ahmad A, Alaref A, Trigo S, Hadi RA, Nour HH, Kotb A, Shahrour W, Elmansy H. Miniaturized Ambulatory Percutaneous Nephrolithotomy Versus Flexible Ureteroscopy in the Management of Lower Calyceal Renal Stones 10-20 mm: A Propensity Score Matching Analysis. Urology 2021; 156:65-70. [PMID: 34097943 DOI: 10.1016/j.urology.2021.05.041] [Citation(s) in RCA: 1] [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: 02/17/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy of ambulatory mini percutaneous nephrolithotomy (Mini-PCNL) and flexible ureteroscope (F-URS) in treating 10-20 mm lower calyceal stones using propensity score matching analysis (PSM). PATIENTS AND METHODS A retrospective analysis of 136 adult patients that underwent Mini-PCNL or F-URS for a single lower calyx calculus. Participants that underwent F-URS were allocated to Group I, while those who underwent Mini-PCNL were assigned to Group II. Patients were discharged on the same day and followed up by CT after 3 months. Both groups were matched by stone size and density using propensity stone matching (PSM) and the matched group were further compared. RESULTS Before matching, there were statistical differences in stone size (P = .02), preoperative hydronephrosis (P = .004), and Hounsfield Unit (P = .04) between both groups. A logistic regression model was created between independent variables such as stone size and density. The new groups following PSM were statistically similar in terms of age, BMI, stone size, and HFU (P = .43, P = .74, P = .49, P = .36). The stone-free rates after PSM was not significantly higher in the Mini-PCNL group than the F-URS group (91.7% vs 81.7%, respectively P = .1) while the operative time for the F-URS group was significantly shorter than the Mini-PCNL group 54 (49-64.3) minutes vs 68.2 (62-73.5) minutes, respectively, P = .045. CONCLUSION Ambulatory Mini-PCNL and F-URS have a comparable hospital stay, stone-free rates, and complication rates for treating lower calyceal stones 10-20 mm. Both techniques may be considered acceptable treatment options, with a prolonged operative time in Mini-PCNL.
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Affiliation(s)
- Waleed Shabana
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Fabiola Oquendo
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Abdulrahman Ahmad
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Amer Alaref
- Radiology Departmet, Northern Ontario School of Medicine, Thuder Bay, Ontario, Canada
| | - Sabrina Trigo
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Hani H Nour
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada.
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Trigo S, Gonzalez K, Di Matteo L, Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Bacillus Calmette-Guerin vaccine and bladder cancer incidence: Scoping literature review and preliminary analysis. Arch Ital Urol Androl 2021; 93:1-8. [PMID: 33754600 DOI: 10.4081/aiua.2021.1.1] [Citation(s) in RCA: 1] [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: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Bacillus Calmette-Guerin (BCG) vaccine has long been used for the prevention of tuberculosis (TB) around the world. BCG is also used as an immunotherapy agent for the treatment of non-muscle invasive urinary bladder cancer. This scoping literature review and preliminary data analysis aims to summarize the literature correlating infantile BCG vaccination with the incidence of future bladder cancer. METHODS Studies were identified by a formal literature search of MEDLINE and Cochrane Central Registrar of Controlled Trials following PRISMA guidelines. Preliminary data analysis was conducted on publicly accessible data summarizing the impact of gender, BCG vaccination, and socio-economic effects on crude and age-standardized rates of bladder cancer. RESULTS As part of our analysis, preliminary regression models demonstrated BCG vaccination status, gender, and socio-economic status to have statistically significant effects on crude and age-standardized rates of bladder cancer incidence. BCG vaccination was associated with a 35-37% lower age-standardized rate of bladder cancer incidence. CONCLUSIONS There is very little literature examining the relationship between prior BCG vaccination and rates of bladder cancer incidence. Our limited data analysis indicates that a relationship does exist between infantile BCG vaccination and later bladder cancer development, although extensive future investigation is needed in this area.
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Affiliation(s)
- Sabrina Trigo
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | | | - Livio Di Matteo
- Department of Economics, Lakehead University, Thunder Bay, ON.
| | - Asmaa Ismail
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Hazem Elmansy
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | | | - Owen Prowse
- Northern Ontario School of Medicine, Thunder Bay, ON.
| | - Ahmed Kotb
- Northern Ontario School of Medicine, Thunder Bay, ON.
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31
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Labine M, Cappello M, Garon R, Skogberg J, Shahrour W, Elmansy H. Case report: Caustic foreign body insertion into the male urethra. Urol Case Rep 2020; 33:101397. [PMID: 33102095 PMCID: PMC7574152 DOI: 10.1016/j.eucr.2020.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 11/02/2022] Open
Abstract
Self-insertion of foreign bodies into the male urethra is a rare presentation. We report a unique case of urethral insertion involving three AAA batteries and the resulting battery acid leakage and urinary obstruction. This report discusses the approach to management, extraction techniques and effects of battery acid within the male urethra.
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32
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Hodhod A, Oquendo F, Tablowski T, Abdul-Hadi R, Shahrour W, Kotb A, Prowse O, Elmansy H. 'Top-Down' holmium laser enucleation of the prostate. Report of initial cases performed by a single surgeon. Arab J Urol 2020; 19:130-136. [PMID: 34104486 PMCID: PMC8158276 DOI: 10.1080/2090598x.2020.1805964] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives To present the 12-month outcomes of ‘Top-Down’ holmium laser enucleation of the prostate (HoLEP). Patients and methods We retrospectively reviewed the charts of prospectively collected patients who underwent Top-Down HoLEP between 2017 and 2018. All cases were operated upon by a single urologist (H.E), using a 100-W holmium:YAG laser with a 550-μm laser fibre. We recorded the enucleation time, morcellation time, intraoperative, and postoperative complications. All patients had postoperative follow-up visits at 1, 3, 6 and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, measurement of maximum urinary flow rate (Qmax) and the post-void residual urine volume (PVR). Results A total of 60 consecutive patients were recruited. The median (range) prostatic volume, resected prostatic weight, and percentage of resected prostatic tissue were 124 (70–266) mL, 90 (44–242) g and 76 (46–97)%, respectively. The median (range) enucleation and morcellation times were 80 (25–200) and 14.5 (4–58) min, respectively. One patient had a simple bladder mucosal injury and another developed clot retention. At 3 months, three patients (5%) had stress urinary incontinence (SUI) and eight patients (13.3%) presented with urge UI (UUI). At the last follow-up visit, one patient (1.7%) presented with persistent SUI, while three patients (5%) presented with UUI. The IPSS and QoL significantly improved during the follow-up period (P = 0.045 and P = 0.04, respectively). Conclusion The results of the Top-Down technique are comparable to those of traditional HoLEP. However, the Top-Down technique may reduce the complexity, operating time, and SUI rates. Abbreviations BN: bladder neck; HoLEP: holmium laser enucleation of the prostate; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QoL: quality of life; TOV: trial of voiding; (S)(U)UI: (stress) (urge) urinary incontinence
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Affiliation(s)
- Amr Hodhod
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Fabiola Oquendo
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Thomas Tablowski
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ruba Abdul-Hadi
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Nour HH, Kamel AI, Elmansy H, Badawy MH, Shabana W, Abdelwahab A, Elbaz A, Eleithy T, Rushdy M. Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country. Arab J Urol 2020; 18:181-186. [PMID: 33029429 PMCID: PMC7473316 DOI: 10.1080/2090598x.2020.1749800] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the management of large ureteric stones (>10 mm) with ureterorenoscopy (URS) and laser or pneumatic lithotripsy, and their associated costs. Patients and methods Our prospective study followed the tenets of the Declaration of Helsinki and included 101 patients with large mid-ureteric stones eligible for URS and lithotripsy, and was conducted between January 2018 and August 2019. Patients were randomly divided into two groups: Group 1 had laser lithotripsy, while the Group 2 had lithotripsy using a pneumatic energy source. Results Operative time was significantly longer in cases using pneumatic lithotripsy (P < 0.001). The stone-free rate (SFR) on the first postoperative day was 94% and 92.5% for laser and pneumatic lithotripsy respectively, and there were no statistically significant differences in terms of early (day 1) or late (day 30) SFRs between the groups. Complications were classified according to the Clavien–Dindo Grading System, all complications were Grade <III, with no statistically significant difference between the groups (P = 0.742). The use of pneumatic lithotripsy had lower treatment costs. The number of auxiliary procedures required to reach a stone-free status was statistically equivalent in both groups. Conclusion The type of lithotripsy did not affect the SFR or complications. However, laser lithotripsy was much more expensive than pneumatic lithotripsy. Abbreviations KUB: plain abdominal radiograph of the kidneys, ureters and bladder; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: Ureterorenoscopy; US: ultrasonography
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Affiliation(s)
- Hani H Nour
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed I Kamel
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hazem Elmansy
- Department of Urology, Thundar Bay Regional Health Sciences Center, Thunder Bay, ON, Canada
| | - Mohamad H Badawy
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Waleed Shabana
- Department of Urology, Zagazig University, Zagazig, Egypt
| | - Ayman Abdelwahab
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed Elbaz
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Tarek Eleithy
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mamdouh Rushdy
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
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Rolf D, Elsayad K, Meheissen MAM, Elkerm Y, Opitz C, Radke I, Bremer A, Hülskamp A, Elsaka R, Ismail HM, Elfaham E, Ismail AA, Elmansy H, Wardelmann E, Elsaid AA, Krause-Bergmann B, Tio J, Eich HT, Micke O. Impact of Adjuvant Radiation Therapy in Patients With Male Breast Cancer: A Multicenter International Analysis. Adv Radiat Oncol 2020; 5:345-349. [PMID: 32529127 PMCID: PMC7276673 DOI: 10.1016/j.adro.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose Breast cancer in men accounts for approximately 1% of all breast cancers. Breast cancer trials have routinely excluded men. The aim of this analysis was to determine the effect of different treatment factors, in particular, postoperative radiation therapy (RT) on long-term outcomes. Methods and Materials Seventy-one patients with male breast cancer treated in 5 closely cooperating institutions between 2003 and 2019 were analyzed. Results Almost all patients (95%) underwent surgical resection. Forty-two patients (59%) received chemotherapy, and 59 (83%) received adjuvant hormonal therapy. Of the 71 patients, 52 (73%) were treated with RT. The rate of recurrence was 20% in the whole cohort, with a locoregional recurrence rate of 3%. In the entire group, the 5-year local control (LC) was 95%, whereas 5-year progression-free survival (PFS) and 5-year overall survival (OS) were 62% and 96%, respectively. There was a lower rate of relapses after adjuvant RT (19% vs 32%, P = .05) without in-field relapse after postoperative RT (0%) versus 10% in patients without RT (P = .02). In the multivariate analysis performed, hormonal therapy administration was found to have a possible significant effect on LC and PFS. Administration of adjuvant RT and stage affect PFS. In patients who received RT, there were no grade 3 or 4 acute toxicities. Conclusions Adjuvant RT is an effective and safe treatment for male breast cancer patients with no infield relapses and better PFS. Hormonal therapy administration was found to have a possible effect on LC and PFS.
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Affiliation(s)
- Daniel Rolf
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Mohamed A M Meheissen
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt.,Specialized Universal Network of Oncology (SUN), Alexandria, Egypt
| | - Yasser Elkerm
- Specialized Universal Network of Oncology (SUN), Alexandria, Egypt.,Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Carl Opitz
- Department of Gynecology & Obstetrics, University Hospital Münster, Münster, Germany
| | - Isabel Radke
- Department of Gynecology & Obstetrics, University Hospital Münster, Münster, Germany
| | - Anne Bremer
- Department of Oncology, St. Franziskus-Hospital, Münster, Germany
| | - Anne Hülskamp
- Department for Breast Diseases, St. Franziskus-Hospital, Münster, Germany
| | - Rasha Elsaka
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt.,Specialized Universal Network of Oncology (SUN), Alexandria, Egypt
| | - Horeya M Ismail
- Specialized Universal Network of Oncology (SUN), Alexandria, Egypt
| | - Essam Elfaham
- Specialized Universal Network of Oncology (SUN), Alexandria, Egypt
| | - Abdelsalam Attia Ismail
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt.,Specialized Universal Network of Oncology (SUN), Alexandria, Egypt
| | - Hazem Elmansy
- Specialized Universal Network of Oncology (SUN), Alexandria, Egypt.,Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Amr Abdelaziz Elsaid
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt.,Specialized Universal Network of Oncology (SUN), Alexandria, Egypt
| | | | - Joke Tio
- Department of Gynecology & Obstetrics, University Hospital Münster, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Bielefeld, Germany
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Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Solitary prostatic cancer metastasis to the testis: A case report and lessons to learn. ACTA ACUST UNITED AC 2020; 91:265-266. [PMID: 31937094 DOI: 10.4081/aiua.2019.4.265] [Citation(s) in RCA: 1] [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: 08/17/2019] [Accepted: 09/01/2019] [Indexed: 11/23/2022]
Abstract
Prostate cancer (Pca) is a complex disease. Several case series and reports have described the spread of Pca to unusual organs, like esophagus, eye and periureteric fat causing ureteropelvic junction obstruction. Spread of Pca to the testis has been reported in few case reports, however Pca was always firstly diagnosed in all published cases and testicular spread of cancer has been diagnosed during follow up of the patients. This case is unique in that, the patient initially presented with a testicular mass and histologic examination after orchiectomy allowed to diagnose prostatic cancer. This patient was 81 years old and he never had PSA screening by his family doctor. PSA was not even done initially by us considering his age and the presentation with testicular mass. This case may impact clinical practice in several ways: 1) considering Pca always in the differential diagnosis of any disease of an adult man, regardless of its presentation because we did not do that at initial patient evaluation and PSA was only measured after orchiectomy when pathology demonstrated metastatic Pca; 2) suggesting standard orchiectomy with epididemectomy for surgical castration instead of the current surgical technique of subcapsular/subepididymal orchiectomy, because our patient had cancer involving his epididymis as well; 3) suggesting to include PSMA as a part of preoperative staging for high risk Pca patients, in consideration that PSMA is proving to be a promising new imaging technique that can help diagnosing metastatic Pca in unusual locations.
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Affiliation(s)
- Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
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Ismail A, Oquendo F, Allard-Ihala E, Elmansy H, Shahrour W, Prowse O, Kotb A. Transverse Lumbotomy for Open Partial/Radical Nephrectomy: How I Do It. Urol Int 2019; 104:131-134. [PMID: 31825948 DOI: 10.1159/000504787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/18/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Conventional open surgical techniques allow proper surgical management for renal malignancies but have their intrinsic drawbacks. The aim of this paper is to present our technique in minimal renal exposure while avoiding the intrinsic complications of conventional techniques. METHODS We described our technique, which can be easily understood and replicated by urologists performing open kidney surgery. RESULTS Ninety-five patients had this technique done safely over the last 4 years, and 3 patients had this exposure changed into intraperitoneal extended wound for very large upper pole tumours. The median operating time was 70 min. No single patient required intraoperative blood transfusion. Median warm ischemic time was 9 min. CONCLUSION Transverse lumbotomy is a safe reproducible technique that allows proper kidney exposure through a relatively smaller wound and avoiding unnecessary auxiliary techniques as rib resection, pleural tear management, and intraperitoneal exposure.
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Affiliation(s)
- Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Fabiola Oquendo
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Erika Allard-Ihala
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada,
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Beltagy A, Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Sunitinib cause delayed complete response on metastatic RCC and extensive IVC thrombus, but not to the kidney tumor: a case report and review of literature. J Surg Case Rep 2019; 2019:rjz326. [PMID: 31737248 PMCID: PMC6847936 DOI: 10.1093/jscr/rjz326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
The role of cytoreductive nephrectomy for metastatic renal cell carcinoma (RCC) is currently debated, with the advancements in target therapy development. The aim of our work was to present an interesting case report with mini review to describe the important role of cytoreductive nephrectomy for kidney cancer control that failed to respond well to Sutent, in spite of good response for all metastases. Medline review of related English publication was conducted and included to the study. RCC response to Sutent is inferior to the response of its metastases. Cytoreductive nephrectomy still plays an important role in metastatic RCC and may be an integral part for cancer control, in properly selected patients.
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Affiliation(s)
- Ahmad Beltagy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Oquendo F, Ismail A, Elmansy H, Shahrour W, Prowse O, Escott N, Kotb A. Accidentally Discovered Testicular Tumor Through MRI Spine. Urology 2019; 136:6-8. [PMID: 31536741 DOI: 10.1016/j.urology.2019.08.045] [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: 07/12/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Fabiola Oquendo
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Nicholas Escott
- Deparment of Pathology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
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Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Very late locally recurrent chromophobe renal cell carcinoma: 15 years following radical nephrectomy for low-stage disease. J Surg Case Rep 2019; 2019:rjz257. [PMID: 31528331 PMCID: PMC6736281 DOI: 10.1093/jscr/rjz257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
The majority of patients with renal cell carcinoma develop recurrence within 5 years following radical nephrectomy. Very late sole local recurrence beyond 10 years is rare, and all reported cases had clear cell histology. Surgical resection of local recurrence remains the best option for disease management. This case opens the way for further studying the rare histological variants of renal cancer and to encourage prolonged follow-up and offering surgery as the best option for managing these cases.
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Affiliation(s)
- Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Owen Prowse
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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Labib M, Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Adrenalectomy for huge solid pheochromocytoma: a challenging surgery or piece of cake? J Surg Case Rep 2019; 2019:rjz255. [PMID: 31462986 PMCID: PMC6705450 DOI: 10.1093/jscr/rjz255] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 12/17/2022] Open
Abstract
Pheochromocytoma (PCC) is an uncommon adrenal tumor that is occasionally diagnosed during the work up for patients with uncontrolled hypertension. Treatment of PCC is mainly surgical. This case represents the largest PCC reported to date, which was safely removed.
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Affiliation(s)
- Mahmoud Labib
- Anesthesia Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Elmansy H, Hodhod A, Kotb A, Prowse O, Shahrour W. Top-down Holmium Laser Enucleation of the Prostate: Technical Aspects and Early Outcomes. Urology 2019; 126:236. [DOI: 10.1016/j.urology.2019.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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Hodhod A, Oquendo F, Nour H, Kelly R, Shahrour W, Kotb A, Prowse O, Elmansy H. The ex vivo and in vivo Characteristics of New DrillCut TM Prostate Morcellator after Holmium Laser Enucleation of the Prostate: A Pilot Study. Urol Int 2019; 103:95-101. [DOI: 10.1159/000499092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
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Rivera M, Lingeman J, York N, Elmansy H, Krambeck A. PD23-08 TRUE COST OF MORCELLATION: COMPARISON OF THE LUMENIS® VERSACUT™ AND WOLF PIRANHA MORCELLATORS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1072] [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: 11/28/2022]
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Rivera M, Lingeman J, Mellon M, York N, Elmansy H, Krambeck A. PD30-05 RISK FACTORS PREDICTING POST-PERCUTANEOUS NEPHROLITHOTOMY TRANSFUSION. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1370] [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: 10/19/2022]
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Elmansy H, Hussaen J, Elhilali M, Andonian S. Pyelocystostomy for treatment of recurrent nephrolithiasis and ureteropelvic junction obstruction in a pelvic kidney. Can J Urol 2016; 23:8480-8482. [PMID: 27705735] [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: 06/06/2023]
Abstract
Patients with pelvic kidneys are at an increased risk of developing ureteropelvic junction obstruction (UPJO) and nephrolithiasis with limited endourologic options. A 54-year-old man with a left pelvic kidney, recurrent nephrolithiasis, and 12 previous ureteroscopies presented with left UPJO and lower pole calyceal stones. After two failed ureteroscopic attempts, an open pyelolithotomy and pyelocystostomy were performed. After 30 months, he continues to be asymptomatic without recurrence of nephrolithiasis. This constitutes the fifth such reported case. Therefore, pyelocystotomy is a good option for patients with pelvic kidneys, UPJO and recurrent nephrolithiasis refractory to endourologic procedures.
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Affiliation(s)
- Hazem Elmansy
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Elshal A, Elmansy H, Elhilali M. 2000 TWO PROSTATE LASER ABLATION TECHNIQUES: LESSONS LEARNED 70 MONTHS AFTER A RANDOMIZED CONTROLLED TRIAL. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2419] [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: 11/28/2022]
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Elshal A, Elmansy H, Elhilali M. 2167 CAN WE PREDICT THE OUTCOME OF GREEN LIGHT LASER PVP (PHOTOSELECTIVE VAPORIZATION OF PROSTATE)? TIME TO EVENT ANALYSIS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2340] [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: 11/28/2022]
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Elmansy H, Kotb A, Elhilali M. 2105 STRESS URINARY INCONTINENCE FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE: IS THERE A WAY TO PREDICT? J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2301] [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: 11/25/2022]
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Elmansy H, Baazeem A, Kotb A, Badawy H, Riad E, Emran A, Elhilali M. 2107 HOLMIUM LASER ENUCLEATION (HOLEP) VERSUS PHOTO SELECTIVE VAPORIZATION (GREEN LIGHT HPS) OF PROSTATIC ADENOMA GREATER THAN 60 ML: PRELIMINARY RESULTS OF PROSPECTIVE RANDOMIZED CLINICAL TRIAL. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Elmansy H, Kotb A, Elhilali M. 2270 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) USING GREEN LIGHT HPS: IS OUTCOME SIZE DEPENDENT? J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2513] [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: 10/18/2022]
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