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ElSheemy MS. Postnatal management of children with antenatal hydronephrosis. Afr J Urol 2020. [DOI: 10.1186/s12301-020-00097-8] [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] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundPostnatal management of infants with antenatal hydronephrosis (ANH) is still one of the most controversial issues. The majority of infants with ANH are asymptomatic with only few children who develop renal insufficiency. Thus, the biggest challenge for pediatric urologists is to distinguish children who will require further investigations and possible intervention prior to the development of symptoms, complications or renal damage in a cost effective manner without exposing them to the hazards of unnecessary investigations.Main bodyIn this review article, literature on ANH were reviewed to present the current suggestions, recommendations, guidelines and their rational for postnatal management of ANH. It is agreed that a large portion of infants with ANH will improve; thus, the protocol of management is based mainly on observation and follow-up by ultrasound to detect either resolution, stabilization or worsening of hydronephrosis. The first 2 years of life are critical for this follow-up as the final picture is mostly reached during that period. Advanced imaging using voiding cystourethrography or renal scintigraphy are required for children at risk. Then, surgical intervention is selected only for a subgroup of these infants who showed worsening of hydronephrosis or renal function.ConclusionsThe protocol of management is based mainly on observation and follow-up by US to detect either resolution, stabilization or worsening of hydronephrosis. Postnatal evaluation should be performed for any neonate with a history ANH at any stage during pregnancy even if it was resolved during third trimester. Exclusion of UTI should be performed by urinalysis for all cases followed by urine culture if indicated. Serum creatinine should be performed especially in patients with bilateral ANH. US is the initial standard diagnostic imaging technique. Other imaging modalities like VCUG and nuclear renal scans may be required according to the results of the US evaluation. The most important items in decision making are the presence of bilateral or unilateral hydronephrosis, presence or absence of hydroureter, presence of lower urinary tract obstruction and degree of hydronephrosis on the initial postnatal US. Then an intervention is selected only for a subgroup of these patients who showed deterioration in renal function or degree of hydronephrosis or were complicated by UTIs. All these recommendations are based on the available literature. However, management of ANH is still a controversial issue due to lack of high evidence-based recommendations. Randomised controlled studies are still needed to provide a high level evidence for different aspects of management.
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Salah M, ElSheemy MS, Ghoneima W, Abd El Hamid M, Kassem A, Ashmawy AA, Saad IR, Mosharafa AA, Salem HK, Badawy H, Salem A. Modified R.E.N.A.L nephrometry score for predicting the outcome following partial nephrectomy. Afr J Urol 2020. [DOI: 10.1186/s12301-020-00056-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
Background
It was difficult to compare the outcome of partial nephrectomy among different studies due to the absence of standardized description of different renal masses. This problem led to the development of nephrometry scoring systems. R.E.N.A.L. is among the commonest nephrometry scoring systems; however, some studies failed to find any relation between R.E.N.A.L. with perioperative outcome. We evaluated our designed newly modified nephrometry score in prediction of outcome following partial nephrectomy and compared its predictability versus original R.E.N.A.L.
Methods
Fifty-one patients with cT1-2N0M0 renal masses amenable for partial nephrectomy were included prospectively. Different perioperative outcome variables were compared according to complexity level in R.E.N.A.L. and the newly modified nephrometry score.
Results
Clinical staging was T1a (21.6%), T1b (49%), T2a (25.5%), T2b (3.9%). Median R.E.N.A.L. was 9 (4–12). Hilar position and intrarenal pelvis were detected in 19.6% and 68.6%. Low, moderate and high complexity masses were found in 21.6%, 39.2% and 39.2%. Complications and rate of conversion to radical nephrectomy were 17 (33.3%) and 4 (7.8%). The only significantly affected variable (p = 0.039) by R.E.N.A.L. was rate of secondary intervention, but it was higher in low than in high complexity level. In the newly modified nephrometry score, complications (p = 0.037) and rate of positive surgical margin (p = 0.049) were significantly higher with increased complexity level. Although other variables (pelvi-calyceal system entry, operative time, blood loss, hemoglobin loss, blood transfusion and conversion to radical nephrectomy) did not show statistically significant difference according to both scores, they were better associated with the complexity level in the newly modified nephrometry score with their remarkable increase in the high when compared to the low complexity level.
Conclusions
The newly modified nephrometry score was associated with better prediction of outcome of partial nephrectomy when compared to R.E.N.A.L.
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Al-Dessoukey AA, ElSheemy MS, Abdallah M, Moussa AS, Sayed O, Abdallah R, Massoud AM, Abdelhamid MH, Ragheb AM, Ghoneima W, Abdelbary AM, Elmarakbi AA. Ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study. Int J Urol 2020; 28:33-39. [PMID: 32985780 DOI: 10.1111/iju.14381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones compared with slow-rate, power-ramping shock wave lithotripsy. METHODS This was a randomized trial enrolling patients with a single high attenuation value (≥1000 HU) upper ureteric stones between January 2019 and July 2019. Ultraslow full-power shock wave lithotripsy (54 patients) was applied at a rate of 30 shock waves/min with power ramping from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18-22 kV for 100 shock waves, then a safety pause for 2 min. Then, full power (22 kV) was maintained until the end of the session. Slow-rate, power-ramping shock wave lithotripsy (47 patients) was applied at a rate of 60 shock waves/min with power ramping from 6 to 10 kV during the first 500 shock waves, then from 11 to 22 kV during the next 1000 shock waves, then maintained on 22 kV in the last 1500 shock waves. Up to three sessions were carried out with a follow up 3 months after the last session. The primary outcome was the stone-free rate. Perioperative data of the two protocols were compared. RESULTS There was no significant difference in preoperative data. The stone-free rate was significantly higher in ultraslow full-power shock wave lithotripsy after single (92.6% vs 23.4%) and multiple (96.3% vs 63.8%) sessions. Most complications were mild, with no significant difference between both groups (9.3% vs 12.8%; P = 0.573). Logistic regression analysis identified ultraslow full-power shock wave lithotripsy protocol as the only significant independent factor for the stone-free rate (odds ratio 12.589, P = 0.025). CONCLUSION Ultraslow full-power shock wave lithotripsy for high attenuation value upper ureteric stones is associated with a significantly higher stone-free rate, and with mild complications that are comparable to those of standard shock wave lithotripsy.
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Affiliation(s)
- Ahmad A Al-Dessoukey
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Mahmoud Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ayman S Moussa
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Osama Sayed
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Amr M Massoud
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Ahmed M Ragheb
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Waleed Ghoneima
- Department of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abdelbary
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Akram A Elmarakbi
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Habib E, Ayman LM, ElSheemy MS, El-Feel AS, Elkhouly A, Nour HH, Badawy MH, Elbaz AG, Roshdy MA. Holmium Laser Enucleation vs Bipolar Plasmakinetic Enucleation of a Large Volume Benign Prostatic Hyperplasia: A Randomized Controlled Trial. J Endourol 2020; 34:330-338. [DOI: 10.1089/end.2019.0707] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Enmar Habib
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Loay M. Ayman
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | - Ahmed S. El-Feel
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Elkhouly
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hany H. Nour
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | - Ahmad G. Elbaz
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
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Al-Dessoukey AA, Abdallah M, Moussa AS, Sayed O, Abdelbary AM, Abdallah R, Massoud AM, Abdelhamid MH, Elmarakbi AA, Ragheb AM, ElSheemy MS, Ghoneima W. Ultraslow full-power shock wave lithotripsy versus slow power-ramping shock wave lithotripsy in stones with high attenuation value: A randomized comparative study. Int J Urol 2019; 27:165-170. [PMID: 31793084 DOI: 10.1111/iju.14158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/29/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of ultraslow full-power versus slow rate, power-ramping shock wave lithotripsy in the management of stones with a high attenuation value. METHODS This was a randomized comparative study enrolling patients with single high attenuation value (≥1000 Hounsfield unit) stones (≤3 cm) between September 2015 and May 2018. Patients with skin-to-stone distance >11 cm or body mass index >30 kg/m2 were excluded. Electrohydraulic shock wave lithotripsy was carried out at rate of 30 shock waves/min for group A versus 60 shock waves/min for group B. In group A, power ramping was from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18-22 kV for 100 shock waves, then a safety pause for 2 min. This full power (22 kV) was maintained until the end of the session. In group B, power ramping was carried out with an increase of 4 kV each 500 shock waves, then maintained on 22 kV in the last 1000-1500 shock waves. Follow up was carried out up to 3 months after the last session. Perioperative data were compared, including the stone free rate (as a primary outcome) and complications (secondary outcome). Predicting factors for success were analyzed using logistic regression. RESULTS A total of 100 patients in group A and 96 patients in group B were included. The stone-free rate was significantly higher in group A (76% vs 38.5%; P < 0.001). Both groups were comparable in complication rates (20% vs 19.8%; P = 0.971). The stone-free rate remained significantly higher in group A in logistic regression analysis (odds ratio 24.011, 95% confidence interval 8.29-69.54; P < 0.001). CONCLUSIONS Ultraslow full-power shock wave lithotripsy for high attenuation value stones is associated with an improved stone-free rate without affecting safety. Further validation studies are required using other shock wave lithotripsy machines.
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Affiliation(s)
- Ahmad A Al-Dessoukey
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mahmoud Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ayman S Moussa
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Osama Sayed
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed M Abdelbary
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Amr M Massoud
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Akram A Elmarakbi
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed M Ragheb
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Waleed Ghoneima
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Seleim HM, ElSheemy MS, Abdalazeem Y, Abdullateef KS, Arafa MA, Shouman AM, Elsaket H, Kaddah SN, Elbarbary MM. Comprehensive evaluation of grafting the preservable narrow plates with consideration of native plate width at primary hypospadias surgery. J Pediatr Urol 2019; 15:345.e1-345.e7. [PMID: 31155410 DOI: 10.1016/j.jpurol.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Dorsal inlay graft urethroplasty using inner-face preputial graft was described as an adjunct method to the classic tubularized incised plate (TIP) urethroplasty, aiming at reducing the risk of neourethral stenosis. OBJECTIVES To evaluate the impact of dorsal inlay grafting of preservable narrow plates, in relation to native plate width. METHODS Consecutive children with penile hypospadias with narrow plate (width < 8 mm) were evaluated prospectively between Jan 2014 and Jun 2018. Included cases were stratified into two groups: group A (plate width: 4 to <8 mm) and group B (plate width: < 4 mm). All cases were approached by TIP urethroplasty, with dorsal inlay grafting (inner-face prepuce). Cases with significant chordee (non-preservable plates), circumcised cases, and redo cases were excluded. RESULTS A total of 104 hypospadias cases with narrow plates were included in this study. Among group A (n = 81), the need for postrepair urethral dilations was reported in two cases (2.5%) vs seven cases (30%) in group B (n = 23) (P-value < 0.001). Another two cases (2.5%) in group A developed urethrocutaneous fistulae vs three cases (13%) in group B (P-value = 0.0624). Surgical repair of the reported five cases with fistulae, revealed an ample neourethral wall; disclosing well-taken grafts in both groups. DISCUSSION Few published studies evaluated grafting the incised plate in penile hypospadias. To the authors knowledge, this is the first study that selectively evaluated the impact of grafting narrow plates in relation to its native pre-incision width. CONCLUSIONS According to the presented authors' experience, 4 mm width is the border line of clinical relevance that defines poor urethral plate. Grafting that plate failed to compensate for its native poor characteristics; however, it offered a valuable neourethral wall that proved indispensable when redo surgery deemed necessary, without adding grafting-related problems. Nevertheless, further extended comparative studies came across as a necessity to verify the long-term outcomes of grafting the incised poor plates.
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Affiliation(s)
- H M Seleim
- Pediatric Surgery Unit, Tanta University, Egypt.
| | - M S ElSheemy
- Pediatric Urology Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Y Abdalazeem
- Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - K S Abdullateef
- Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - M A Arafa
- Pediatric Surgery Unit, Tanta University, Egypt
| | - A M Shouman
- Pediatric Urology Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - H Elsaket
- Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - S N Kaddah
- Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - M M Elbarbary
- Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
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ElSheemy MS, Ghoneima W, Elmarakbi AA, Al-Kandari AM, Ibrahim H, Shrestha S, Khadgi S. Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study. Urology 2018; 120:62-67. [DOI: 10.1016/j.urology.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/30/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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ElSheemy MS, Elmarakbi AA, Hytham M, Ibrahim H, Khadgi S, Al-Kandari AM. Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study. Urolithiasis 2018; 47:207-214. [PMID: 29549382 DOI: 10.1007/s00240-018-1055-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
Abstract
To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm2; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm2), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm2), but not with single stones or stone burden ≤ 2 cm2.
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Affiliation(s)
| | | | - Mohammed Hytham
- Urology department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hamdy Ibrahim
- Urology Department, Fayoum University, Fayoum, Egypt
| | - Sanjay Khadgi
- Vayodah and Venus International Hospitals, Kathmandu, Nepal
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ElSheemy MS, Ghoneima W, Aboulela W, Daw K, Shouman AM, Shoukry AI, Soaida S, Salah DM, Bazaraa H, Fadel FI, Hussein AA, Habib E, Saad IR, El Ghoneimy M, Morsi HA, Lotfi MA, Badawy H. Risk factors for urological complications following living donor renal transplantation in children. Pediatr Transplant 2018; 22. [PMID: 29082641 DOI: 10.1111/petr.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to detect possible risk factors for UC and UTI following pediatric renal Tx and effect of these complications on outcome. One hundred and eight children who underwent living donor Tx between 2009 and 2015 were retrospectively included. Extraperitoneal approach was used with stented tunneled extravesical procedure. Mean recipient age was 9.89 ± 3.46 years while mean weight was 25.22 ± 10.43 kg. Seventy-three (67.6%) recipients were boys while 92 (85.2%) were related to donors. Urological causes of ESRD were present in 33 (30.6%) recipients (14 [13%] posterior urethral valve, 16 [14.8%] VUR, and 3 [2.8%] neurogenic bladder). Augmentation ileocystoplasty was performed in 9 (8.3%) patients. Mean follow-up was 39.3 ± 17.33 months. UC were detected in 10 (9.3%) children (leakage 4 [3.7%], obstruction 3 [2.8%], and VUR 3 [2.8%]) while UTIs were reported in 40 (37%) children. After logistic regression analysis, UC were significantly higher in children with cystoplasty (44.4% vs 6.1%; P = .001). UTIs were significantly higher in girls (51.4% vs 30.1%; P = .001) and in children with urological causes of ESRD (51.5% vs 30.7%; P = .049). UC and UTI were not significantly associated with increased graft loss or mortality. UC were significantly higher in children with cystoplasty while UTIs were significantly higher in girls and children with urological causes of ESRD. Presence of UC did not affect the rate of graft loss or mortality due to its early detection and proper management.
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Affiliation(s)
| | - Waleed Ghoneima
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Sherif Soaida
- Division of Pediatric Anesthesia, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Doaa M Salah
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Hafez Bazaraa
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed A Hussein
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Enmar Habib
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Ismail R Saad
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | | | - Hany A Morsi
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohammed A Lotfi
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
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ElSheemy MS, Ghoneima W, Abdelwahhab M, Aboulela W, Daw K, Shouman AM, Shoukry AI, El Ghoneimy M, Morsi HA, Badawy H. The role of voiding cystourethrography in asymptomatic unilateral isolated ureteropelvic junction obstruction: A retrospective study. J Pediatr Urol 2017; 13:206.e1-206.e7. [PMID: 27964829 DOI: 10.1016/j.jpurol.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The presence of concomitant vesicoureteric reflux (VUR) and ureteropelvic junction obstruction (UPJO) is uncommon. Nevertheless, the reported VUR coexisting with asymptomatic unilateral isolated hydronephrosis (AUIH) requiring pyeloplasty for correction of UPJO was of low grade and mostly resolved during conservative follow-up. Therefore, VCUG may be not indicated in these children except if voiding symptoms, urinary tract infection (UTI), dilated ureters, or bladder and ureteric abnormalities are suspected. OBJECTIVES The aim was to evaluate the need for VCUG in infants <1 year old with AUIH for whom a dismembered pyeloplasty was indicated for correction of UPJO. METHODS Ninety-six children <1 year old with pyeloplasty carried out from January 2012 to March 2014 were retrospectively included. Children with voiding symptoms or dilated ureter, duplex system, fused kidneys, bilateral dilatation, or any bladder abnormality on ultrasound were excluded. Anderson-Hynes pyeloplasty was performed through a flank incision. Preoperative VCUG was analyzed in relation to outcome and any UTI during follow-up. The Student t test, Mann-Whitney U test, or Fisher exact test were used to compare variables. RESULTS Five children had concomitant VUR with UPJO. Most of the children were circumcised during the first postnatal week. The remaining few children were circumcised at the time of pyeloplasty. Side, grade of detected VUR, and complications (18.75%) (postoperative or during follow-up) are presented in the Table. Outcomes in children with and without VUR were not different. Dismembered pyeloplasty was successful in children with VUR and with no complications except for non-febrile UTI in one child only. Ureters were still not dilated at the last follow-up. DISCUSSION The required imaging in infants with AUIH is still a subject of debate. As we expected, there was a low incidence of associated VUR in the present study. They were of low grade without any complications during follow-up and without affecting the outcome. The present study has its limitations, including the retrospective nature and short follow-up. However, as at least 2 years of follow-up were documented without any harm or ureteric dilation, VUR will mostly resolve. The present study is strengthened by inclusion of infants only. CONCLUSIONS Our data suggest that VCUG is not indicated in infants with AUIH requiring pyeloplasty for correction of UPJO. VCUG will not affect the treatment decision, operative outcome, or postoperative complications. VCUG may be indicated in case of suspected voiding symptoms, UTI, dilated ureters, or bladder and ureteric abnormalities.
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Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
| | - Waleed Ghoneima
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Mohammad Abdelwahhab
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Mohamed El Ghoneimy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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Nasser FM, Shouman AM, ElSheemy MS, Lotfi MA, Aboulela W, El Ghoneimy M, Abdelwahhab M, Shoukry AI, Ghoneima W, Morsi H, Badawy H. Dismembered Pyeloplasty in Infants 6 Months Old or Younger With and Without External Trans-anastomotic Nephrostent: A Prospective Randomized Study. Urology 2017; 101:38-44. [DOI: 10.1016/j.urology.2016.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
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Al-Kandari AM, Kehinde EO, Khudair S, Ibrahim H, ElSheemy MS, Shokeir AA. Intermittent Testicular Torsion in Adults: An Overlooked Clinical Condition. Med Princ Pract 2017; 26:30-34. [PMID: 27648954 PMCID: PMC5588398 DOI: 10.1159/000450887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/19/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the management protocol for intermittent testicular torsion (ITT) in adults and report the outcome of this clinical condition, which is commonly overlooked in adults. SUBJECTS AND METHODS Sixty-three patients were included in the study. The inclusion criterion was the presence of sudden intermittent testicular pain over a duration of 3 months. All the patients underwent clinical examination, urine analysis, culture, and scrotal ultrasound with Doppler. The testicle was in an abnormal or in transverse lie and/or could easily be twisted. Scrotal support and analgesia were given for 1 month, then patients were offered orchidopexy or conservative treatment. Nineteen patients chose orchidopexy while 44 chose conservative treatment. Follow-up ranged from 3 months to 2 years. The improvement was assessed using a visual analog pain score. The outcome of the treatment was compared between the surgical and conservative groups using a χ2 test. RESULTS The median age of the patients was 28 years (range: 17-50). Of the 19 patients who underwent orchidopexy, the pain resolved or visual analog pain scores improved (median 1/10) in 18 (94.7%) cases. On the other hand, 21 of the 44 (47.7%) cases that chose the conservative approach claimed their pain resolved or improved (visual analog pain scores: median 3/10) with a median of 13 months of follow-up. CONCLUSION In this study, scrotal orchidopexy proved to be superior to conservative measures in cases of ITT in adults.
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Affiliation(s)
- Ahmed M. Al-Kandari
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
- *Ahmed M. Al-Kandari, Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Jabryiah, 4th ring road, P.O. Box 24923, Safat 13110 (Kuwait), E-Mail
| | - Elijah O. Kehinde
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
| | - Salah Khudair
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
| | - Hamdy Ibrahim
- Department of Urology, Fayoum University, Fayoum, Egypt
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Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis 2016; 45:407-414. [DOI: 10.1007/s00240-016-0926-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
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ElSheemy MS, Daw K, Habib E, Aboulela W, Fathy H, Shouman AM, El Ghoneimy M, Shoukry AI, Morsi HA, Badawy H. Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy. Int J Urol 2016; 23:564-70. [PMID: 27173126 DOI: 10.1111/iju.13093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. METHODS From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. RESULTS Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively. CONCLUSIONS The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.
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Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Enmar Habib
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hesham Fathy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Mohamed El Ghoneimy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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Shoukry AI, Abouela WN, ElSheemy MS, Shouman AM, Daw K, Hussein AA, Morsi H, Mohsen MA, Badawy H, Eissa M. Use of holmium laser for urethral strictures in pediatrics: A prospective study. J Pediatr Urol 2016; 12:42.e1-6. [PMID: 26302829 DOI: 10.1016/j.jpurol.2015.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The management of urethral strictures is very challenging and requires the wide expertise of different treatment modalities ranging from endoscopic procedures to open surgical interventions. OBJECTIVE To assess the effectiveness and complications of retrograde endoscopic holmium: yttrium-aluminum-garnet laser (Ho: YAG) urethrotomy (HLU) for the treatment of pediatric urethral strictures. PATIENTS AND METHODS From January 2010 to January 2013, 29 male pediatric patients with a mean age of 5.9 years and primary urethral strictures 0.5-2 cm long were treated using HLU. The stricture length was <1 cm in 16 (55%) patients and >1 cm in 13 (45%). Fifteen (51.7%) patients had an anterior urethral stricture, while 14 (48.3%) had a posterior urethral stricture. No positive history was found in 14 (48.3%) patients for the stricture disease, while six (20.7%) had straddle trauma and nine (31%) had an iatrogenic stricture. All of the patients were pre-operatively investigated and at 3 and 6 months postoperation by uroflowmetry and voiding cystourethrography (VCUG). If there were suspicious voiding symptoms, selective uroflowmetry and VCUG were performed at 12 months postoperation. RESULTS The mean operation time was 31.7 min (20-45 min). Twenty-three (79.3%) and 18 (62.1%) patients showed normal urethra on VCUG with improvement of symptoms at 3 and 6 months, respectively. Thus, recurrence was 37.9% after 6 months of follow-up. The mean pre-operative peak urinary flow rate (Qmax) was 6.47 ml/s. The mean postoperative Qmax at 3 and 6 months was 17.17 ml/s and 15.35 ml/s, respectively. The success rate and flowmetry results did not show any statistical significance in relation to site, length and cause of the strictures. The other 11 patients who failed to improve underwent repeated HLU sessions: 4/11 (36.3%) achieved successful outcomes. Among the seven patients with failed HLU for the second time, a third session was conducted. However, only one patient (14.2%) was cured, while open repair was needed for the remaining six. DISCUSSION One study has previously been published on the management of pediatric urethral strictures using HLU. The present results are similar to short-term studies after a single session of visual internal urethrotomy using cold knife (VIU). In the present study, the length, location and cause of strictures did not significantly affect the results. However, the outcomes with strictures <1 cm were better than strictures >1 cm, although patients with strictures >2 cm were excluded. In the present study, the success rates among patients with second and third sessions of HLU were 36.3% and 14.2%, respectively. This was similar to other studies, which reported low success rate with the second session of VIU. The present study was limited by the relatively short period of follow-up and the small number of patients. However, it was the first prospective study evaluating HLU for pediatric strictures. The use of flowmetry and VCUG for evaluation of all patients added to the strength of the study. CONCLUSION HLU can be safely used with good success rates for the treatment of primary urethral strictures (<2 cm) in children. Repeat HLU (more than twice) adds little to success.
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Affiliation(s)
- A I Shoukry
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - W N Abouela
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - M S ElSheemy
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - A M Shouman
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - K Daw
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - A A Hussein
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - H Morsi
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - M A Mohsen
- Urology Department, Kasr Alainy Hospital, Cairo University, KasrAlainy Street, Cairo, Egypt.
| | - H Badawy
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
| | - M Eissa
- Pediatric Urology Department, Abu El Rish Children Hospital, Cairo University, KasrAlAiny Street, Cairo, Egypt.
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Saad IR, Habib E, ElSheemy MS, Abdel-Hakim M, Sheba M, Mosleh A, Salah DM, Bazaraa H, Fadel FI, Morsi HA, Badawy H. Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study. BJU Int 2015; 118:320-6. [PMID: 26434410 DOI: 10.1111/bju.13347] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 11/27/2022]
Abstract
OBJECTIVES To compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. PATIENTS AND METHODS A database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, Mann-Whitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. RESULTS The mean ± sd (range) age of the study cohort was 5.05 ± 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean ± sd follow-up was 4.52 ± 1.55 and 4.07 ± 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. CONCLUSION Acceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.
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Affiliation(s)
- Ismail R Saad
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Enmar Habib
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mohammed S ElSheemy
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mahmoud Abdel-Hakim
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mostafa Sheba
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Aziz Mosleh
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Doaa M Salah
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hafez Bazaraa
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Division of Pediatric Nephrology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
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Soaida SM, ElSheemy MS, Shouman AM, Shoukry AI, Morsi HA, Salah DM, Fadel FI, Bazaraa HM. Caudal extradural catheterization in pediatric renal transplant and its effect on perioperative hemodynamics and pain scoring: a prospective randomized study. J Anesth 2015; 30:47-54. [PMID: 26493396 DOI: 10.1007/s00540-015-2087-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/02/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE 'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics. METHODS After approval from the ethical committee at Kasr Al Ainy University Hospital and consent from parents/legal guardians, sixty patients aged 3-12 years who were scheduled for renal transplant were randomly divided into two equal groups. Group I (epidural group) received continuous caudal epidural bupivacaine 0.125 % with fentanyl together with intravenous (IV) fentanyl and paracetamol. Group II (control group) received only IV fentanyl and paracetamol. Intraoperative data included heart rate (HR), mean arterial blood pressure (MAP) and central venous pressure (CVP). Postoperative variables included HR, MAP, CVP, pain score and complications. RESULTS Threading failure via the caudal route occurred in 6.67 % of cases. Intraoperative differences in hemodynamics and CVP were not clinically significant between groups. Postoperative HR, MAP, and CVP were generally higher in the control group. Pain control was more satisfactory and postoperative complications were less in the epidural group. CONCLUSION Caudal epidural anesthesia in pediatric renal transplant is a valuable addition to general anesthesia as it provides stable perioperative hemodynamics, excellent postoperative analgesia and is associated with fewer complications than narcotic-dependent analgesia. CLINICAL TRIAL REGISTRATION NUMBER NCT02037802.
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Affiliation(s)
- Sherif M Soaida
- Division of Pediatric Anesthesia, Department of Anesthesia, ICU, and Pain Management, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
- Department of Anesthesia, Kasr al Ainy hospital, Cairo University, Kasr al Ainy street, Cairo, 11562, Egypt.
| | - Mohammed S ElSheemy
- Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
| | - Doaa M Salah
- Pediatric Nephrology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Pediatric Nephrology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
| | - Hafez M Bazaraa
- Pediatric Nephrology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt
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ElSheemy MS, Ghamrawy H, Fathy H, Hussein HA, Hussein EA, Aly A, Rahman SA. Use of surgeon-tailored polypropylene mesh as a needle-less single-incision sling for treating female stress urinary incontinence: Preliminary results. Arab J Urol 2015; 13:191-8. [PMID: 26413346 PMCID: PMC4563014 DOI: 10.1016/j.aju.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/04/2015] [Accepted: 04/30/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of a procedure using surgeon-tailored polypropylene mesh (STM) through a needle-less single-incision technique for treating stress urinary incontinence (SUI), aiming to decrease the cost of treatment, which is important in developing countries. PATIENTS AND METHODS In all, 43 women diagnosed using a cough stress test were treated from January 2011 to June 2013 at the Urology and Gynaecology Departments (dual-centre), Cairo University Hospitals. Previous surgery was not a contra-indication. Patients with a postvoid residual urine volume of >100 mL, a bladder capacity of <300 mL, impaired compliance or neurological lesions were excluded. The Stress and Urge incontinence Quality of life Questionnaire (SUIQQ) and urodynamic variables were compared before and after surgery. The variables were compared between the baseline and postoperative follow-up values using a paired t-test, a Wilcoxon signed-rank test or McNemar's test. RESULTS The mean age was 42.7 years and 20 (47%) patients had associated urgency UI (UUI), whilst 21 (49%) had intrinsic sphincter deficiency. The median (range) operative duration was 14 (5-35) min. There were no complications during surgery. The mean (SD, range) follow-up was 28.1 (5.1, 18-36) months. Postoperative complications were vaginal discharge (5%), failure of wound healing (5%), dyspareunia (5%) and UTI (5%). The sling was removed in one case. SUI, UUI and quality-of-life indices improved significantly after surgery. There were no significant differences in pressure-flow studies before and after surgery. In all, 38 (88%) patients were cured, four (9%) improved and in one only the treatment failed (2%). CONCLUSION This technique is simple, safe, effective, reproducible and economical for treating SUI. The STM was easy to insert in a short operation.
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Key Words
- (M)(U)(S)UI, (mixed) (urge) (stress) urinary incontinence
- ALPP, abdominal leak-point pressure
- CST, cough stress test
- DO, detrusor overactivity
- Female
- ISD, intrinsic sphincter deficiency
- NSIT, needle-less single-incision technique
- PVR, postvoid residual urine
- PdetQmax, detrusor pressure at maximum urinary flow rate
- Polypropylene mesh
- Qmax, maximum urinary flow rate
- QoL, quality of life
- STM, surgeon-tailored ordinary polypropylene mesh
- SUI, stress urinary incontinence
- SUIQQ, Stress and Urge Incontinence Quality of life Questionnaire
- Single incision
- Stress urinary incontinence
- TVT, tension-free vaginal tape
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Affiliation(s)
| | - Hisham Ghamrawy
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Egypt
| | - Hesham Fathy
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Egypt
| | | | - Eman A. Hussein
- Department of Gynecology and Obstetrics, Cairo University, Cairo, Egypt
| | - Ahmed Aly
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Egypt
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Aboulela W, ElSheemy MS, Shoukry AI, Shouman AM, ElShenoufy A, Daw K, Morsi HA, Badawy H. Transurethral Holmium Laser Cystolithotripsy in Children: Single Center Experience. J Endourol 2015; 29:661-5. [DOI: 10.1089/end.2014.0636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Waseem Aboulela
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Mohammed S. ElSheemy
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M. Shouman
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed ElShenoufy
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A. Morsi
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hesham Badawy
- Department of Urology, Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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ElSheemy MS, Fathy H, Hussein HA, Elsergany R, Hussein EA. Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study. Int Urogynecol J 2015; 26:1533-40. [DOI: 10.1007/s00192-015-2725-6] [Citation(s) in RCA: 5] [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: 02/09/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
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ElSheemy MS, Shoukry AI, Shouman AM, ElShenoufy A, Aboulela W, Daw K, Hussein AA, Morsi HA. Management of obstructive calcular anuria with acute renal failure in children less than 4 years in age: a protocol for initial urinary drainage in relation to planned definitive stone management. J Pediatr Urol 2014; 10:1126-32. [PMID: 24953544 DOI: 10.1016/j.jpurol.2014.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 04/12/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe and evaluate our protocol for management of children≤4years old with obstructive calcular anuria (OCA) and acute renal failure (ARF) to improve selection of initial urinary drainage (ID) method and to facilitate subsequent definitive stone management (DSM) as studies discussing this special group of patients are still few. PATIENTS AND METHODS Patients with a contraindication to any method of ID were excluded. Decision (percutaneous nephrostomy (PCN) or double J (JJ) stent) was based on degree of hydronephrosis and planned DSM. We used 4.8-5Fr JJ or 6-8Fr PCN under general anesthesia and fluoroscopic guidance. According to our protocol, JJ is inserted for hydronephrosis≤grade 1. When the hydronephrosis is >grade 1, patients with radiolucent stones were treated by JJ whatever the site of the stone. When the stones were radiopaque, PCN was reserved for stones in a solitary functioning kidney and bilateral ureteric stones prepared for subsequent bilateral ureterolithotomy (or stone prepared for ureterolithotomy in a solitary kidney). After normalization of renal functions, DSM was staged attacking only one side before discharge. Both sides were cleared at the same session in cases with bilateral ureterolithotomy. Renal or ureteric stones suitable for SWL in a solitary kidney were treated with percutaneous nephrolithotripsy (PNL) or ureteroscopy. This was followed also in patients with bilateral stones suitable for SWL by clearing one side using ureteroscopy or PNL before discharge. Open surgery (OS) was reserved for cases with failed ureteroscopy or PNL, for ureteric stones>2.5 cm in size or very large volume complex renal stones. Stone free rate (SFR) was evaluated by CT. Our protocol was evaluated as regard recovery of renal functions, complications, and number of interventions to clear stones. RESULTS This study included 62 boys and 22 girls presented with anuria for 1-4 days. JJ and PCN were inserted in 105 and 30 ureterorenal units (URU), respectively. Creatinine returns normal within 72 h. JJ insertion formed a part of DSM in 78/159 (49%) URU (stones prepared for extracorporeal shockwave lithotripsy or oral chemolytic dissolution therapy). PCN was the ideal tract for subsequent PNL in 11/159 (6.9%) URU. Accordingly, ID participated by 55.97% in DSM. Both operative and imaging times were slightly longer with PCN than JJ. There was no statistically significant difference in the insertion success or mean period to return to normal chemistry. Complications of both methods were mild and without any significant difference. Endourologic procedures constituted the majority of our interventions. Open surgical and endoscopic interventions for clearance of stones (including ID, treatment conversion and 2ry procedures) were done once for 25 patients, twice for 43 patients while it was needed three times for 16 patients. Total number of interventions was 149 procedures. SFR was 94%. CONCLUSION Our protocol ensures adequate ID with minimal complications when using our selection criteria in children≤4 years in age with OCA and ARF. It also minimizes number of subsequent procedures to clear stones. Complications and success in insertion and drainage were equivalent in PCN and JJ groups.
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Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
| | - Ahmed I Shoukry
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed M Shouman
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed ElShenoufy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Kareem Daw
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed A Hussein
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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ElSheemy MS, Elsergany R, ElShenoufy A. Low-cost transobturator vaginal tape inside-out procedure for the treatment of female stress urinary incontinence using ordinary polypropylene mesh. Int Urogynecol J 2014; 26:577-84. [PMID: 25352073 DOI: 10.1007/s00192-014-2552-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/13/2014] [Indexed: 11/27/2022]
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ElSheemy MS, Shouman AM, Shoukry AI, ElShenoufy A, Aboulela W, Daw K, Hussein AA, Morsi HA, Badawy H. Ureteric stents vs percutaneous nephrostomy for initial urinary drainage in children with obstructive anuria and acute renal failure due to ureteric calculi: a prospective, randomised study. BJU Int 2014; 115:473-9. [PMID: 24698195 DOI: 10.1111/bju.12768] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare percutaneous nephrostomy (PCN) tube vs JJ ureteric stenting as the initial urinary drainage method in children with obstructive calcular anuria (OCA) and post-renal acute renal failure (ARF) due to bilateral ureteric calculi, to identify the selection criteria for the initial urinary drainage method that will improve urinary drainage, decrease complications and facilitate the subsequent definitive clearance of stones, as this comparison is lacking in the literature. PATIENTS AND METHODS A series of 90 children aged ≤12 years presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric Hospital in this randomised comparative study. Patients with grade 0-1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication for either method of drainage. Stable patients (or patients stabilised by dialysis) were randomised (non-blinded, block randomisation, sealed envelope method) into PCN-tube or bilateral JJ-stent groups (45 patients for each group). Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance. We used 4.8-6 F JJ stents or 6-8 F PCN tubes. The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions. Both groups were compared for operative and imaging times, complications, and the period required for a return to normal serum creatinine levels. The secondary outcomes included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome within each group. RESULTS All presented patients completed the study with intention-to-treat analysis. There was no significant difference between the PCN-tube and JJ-stent groups for the operative and imaging times, period for return to a normal creatinine level and failure of insertion. There were significantly more complications in the PCN-tube group. The stone size (>2 cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in the JJ-stent group. The degree of hydronephrosis significantly affected the operative time for PCN-tube insertion. Grade 2 hydronephrosis was associated with all cases of insertion failure in the PCN-tube group. The total number of subsequent interventions needed to clear stones was significantly higher in the PCN-tube group, especially in patients with bilateral stones destined for chemolytic dissolution (alkalinisation) or extracorporeal shockwave lithotripsy (ESWL). CONCLUSION We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL, as this will lower the total number of subsequent interventions needed to clear the stones. This is also true for stones destined for ureteroscopy (URS), as JJ-stent insertion will facilitate subsequent URS due to previous ureteric stenting. Mild hydronephrosis will prolong the operative time for PCN-tube insertion and may increase the incidence of insertion failure. We recommend the use of PCN tube if the stone size is >2 cm, as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure.
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Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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ElSheemy MS, Shouman AM, Shoukry AI, Soaida S, Salah DM, Yousef AM, Morsi HA, Fadel FI, Sadek SZ. Surgical complications and graft function following live-donor extraperitoneal renal transplantation in children 20 kg or less. J Pediatr Urol 2014; 10:737-43. [PMID: 24495971 DOI: 10.1016/j.jpurol.2013.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the effect of patient, surgical, and medical factors on surgical complications and graft function following renal transplantation (Tx) in children weighing ≤ 20 kg, because the number of this challenging group of children is increasing. PATIENTS AND METHODS Between June 2009 and October 2013, 26 patients received living donor renal allotransplant using the extraperitoneal approach (EPA). The immunosuppression regimen was composed of prednisolone, mycophenolate mofetil, and ciclosporin or tacrolimus. RESULTS The mean weight was 16.46 ± 2.61 kg. Mean cold ischemia time was 53.85 ± 12.35 min. The graft survival rate (GSR) and patient survival rate (PSR) were 96% at 3 years. Acute rejection episodes (AREs) occurred in eight patients (30%). Postoperative surgical complications were ureteral leakage (3), vesicoureteric reflux (2), and renal vein thrombosis (2) (with one graft nephrectomy). Mean follow-up was 37.5 ± 7.4 months. CONCLUSION Excellent PSR and GSR can be achieved in low weight (<20 kg) recipients. Even in very low weight patients, the EPA was used. No cases were reported with primary graft non-function due to use of living donors, increasing pre-Tx body weight to at least 10 kg and maintaining adequate filling pressure before graft reperfusion. The presence of related donors and use of induction therapy and tacrolimus decreased the rate of ARE while the presence of pre-Tx lower urinary tract surgical interventions increased the rate of ureteric complications, but this was statistically insignificant.
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Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
| | - Ahmed M Shouman
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ahmed I Shoukry
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Sherif Soaida
- Division of Pediatric Anesthesia, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Doaa M Salah
- Division of Pediatric Nephrology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Ali M Yousef
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Division of Pediatric Nephrology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
| | - Sameh Z Sadek
- Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
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Kotb S, ElSheemy MS, Morsi HA, Zakaria T, Salah M, Eissa MA. Renal recoverability in infants with obstructive calcular anuria: is it better than in older children? J Pediatr Urol 2013; 9:1178-82. [PMID: 23769201 DOI: 10.1016/j.jpurol.2013.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Urolithiasis in infants can cause considerable morbidity. The literature regarding calcular anuria in this age group is very defective. Our aim was to evaluate impact of intervention on renal recoverability in these infants. PATIENTS AND METHODS A series of 24 patients presenting with obstructive calcular anuria were included in this study. Mean age was 16.5 ± 6.2 months. They were treated either by initial urinary diversion or definitive endoscopic (ureteroscopy or JJ stenting with medical alkalinization) or open surgical (ureterolithotomy or pyelolithotomy) treatment. RESULTS Mean serum creatinine was 5.8 ± 2.6 mg/dl. Initial peritoneal dialysis and/or urinary diversion was needed in 11 patients (45.8%). Open surgical treatment was applied in 5 (20.8%), endoscopic treatment was applied in 15 (62.5%), while combined treatment was applied in 4 (16.6%) patients. All patients had normal serum creatinine on discharge. Three (12.5%) had residual stones which were cleared by 2ry ureteroscopic intervention at 6 months. The overall complication rate in this study was 12.5% in the form of postoperative leakage (1) and postoperative fever (2). No mortality or development of chronic renal failure was reported at 6 months follow up. In comparison with these results, a previous study carried out in our centre on an older age group had a higher complication rate (28%) with higher mortalities and lower renal function recoverability rate (94%). CONCLUSIONS Appropriate and timely medical and surgical management of calcular anuria will mostly lead to full recovery of renal functions. In comparison with older children, renal prognosis in those less than 2 years seems more favorable.
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Affiliation(s)
- Sameh Kotb
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt
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ElSheemy MS. Editorial comment from Dr ElSheemy to extracorporeal shockwave lithotripsy for renal stones in pediatric patients: a multivariate analysis model for estimating the stone-free probability. Int J Urol 2013; 20:1210-1. [PMID: 23490177 DOI: 10.1111/iju.12138] [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: 11/29/2022]
Affiliation(s)
- Mohammed S ElSheemy
- Division of Pediatric Urology, AboulRiche Children's Hospital, Cairo University, Cairo, Egypt.
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