Ahmed B. Shehab El-Din

An Appliance-Free, Sphincter-Controlled Bladder Substitute: The Urethral Kock Pouch

A modified Kock pouch was constructed in 16 patients with cancer of the bladder in whom cystoprostatectomy was indicated. Surgery entailed creation of a Kock pouch with 1 valve for prevention of reflux. The pouch then was anastomosed to the urethral stump. There was no operative mortality. Followup ranged between 3 and 9 months. Excretory urograms revealed excellent upper tract function and good evacuation of the pouch with minimal residual urine. Urodynamic studies demonstrated a volume capacity of greater than 300 ml., with pressures of less than 40 cm. water. All patients were continent during the day. Nocturnal enuresis was observed in 4 patients, 3 of whom responded favorably to I-desamino-8-D-arginine vasopressin therapy. The procedure is suitable whenever the urethra can be preserved after cystectomy for cancer.

Decline of viral hepatitis prevalence among asymptomatic Egyptian blood donors: A glimmer of hope

BACKGROUND Viral hepatitis is an important etiological agent of chronic hepatitis and liver disease and is a major cause of morbidity and mortality especially in Egypt since it has the highest prevalence of hepatitis C virus (HCV) infection. We aimed to assess if there is any change in the annual seroprevalence of both HCV and hepatitis B virus (HBV) infection in Egypt in the current era. METHODS Our study included 55,922 potentially healthy asymptomatic blood donors; 52,280 males and 3642 females with mean age of 30.98+/-8.6 years. All of them were volunteers for the first time and 70% were from rural areas. We applied our own questionnaire that included past medical history, surgical history, and history of blood donation. We screened their sera for the presence or absence of anti-HCV antibodies with the 3rd generation enzyme-linked immunosorbent assay (ELISA) and the presence or absence of hepatitis B surface antigen (HBsAg) with ELISA. RESULTS The cumulative seroprevalence of HCV and HBV infection was 11.95% and 1.3% respectively. The annual seroprevalence of both viruses showed a declining pattern throughout the study period from 17.7% to 7.4% regarding HCV and HBV infection from 2.3% to 0.9%. The decline trends for both viral infections were observed for both genders. CONCLUSION This study carries a glimmer of hope because of a decline in seroprevalence of viral hepatitis in Egypt. However stringent implementation of infection control programs in Egypt is mandatory to face this furious health problem.

Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

Abstract:  To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post‐transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post‐transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post‐transplant hypertension. The independent determinants of graft survival in live‐donor pediatric and adolescent renal transplant recipients are acute rejection and post‐transplant hypertension.

Magnetic resonance imaging as a sole method for the morphological and functional evaluation of live kidney donors

In this section, authors from Mansoura describe their experience with MRI as the sole method for the morphological and functional evaluation of live kidney donors. They recommend this technique in both instances.

Tissue engineering and stem cells: Basic principles and applications in urology

To overcome problems of damaged urinary tract tissues and complications of current procedures, tissue engineering (TE) techniques and stem cell (SC) research have achieved great progress. Although diversity of techniques is used, urologists should know the basics. We carried out a literature review regarding the basic principles and applications of TE and SC technologies in the genitourinary tract. We carried out MEDLINE/PubMed searches for English articles until March 2010 using a combination of the following keywords: bladder, erectile dysfunction, kidney, prostate, Peyronies disease, stem cells, stress urinary incontinence, testis, tissue engineering, ureter, urethra and urinary tract. Retrieved abstracts were checked, and full versions of relevant articles were obtained. Scientists have achieved great advances in basic science research. This is obvious by the tremendous increase in the number of publications. We divided this review in two topics; the first discusses basic science principles of TE and SC, whereas the second part delineates current clinical applications and advances in urological literature. TE and SC applications represent an alternative resource for treating complicated urological diseases. Despite the paucity of clinical trials, the promising results of animal models and continuous work represents the hope of treating various urological disorders with this technology.

Bladder Substitutes Controlled by the Anal Sphincter: A Comparison of the Different Absorption Potentials

A comparative study of the absorption potentials of the simple rectal bladder (10 patients), modified rectal bladder (20) and ureterosigmoidostomy (10) was done with intrarectal instillation of 22sodium. Results indicate that absorption is significantly greater among patients with ureterosigmoidostomy. The emptying patterns of ureterosigmoidostomy and the modified rectal bladder were also studied by ascending scintigraphy with 99mtechnetium. Evidence was provided that in cases with ureterosigmoidostomy the isotope is distributed throughout the entire colon. These studies proved the role of the colorectal valve in preventing reflux of urine from the rectum to the proximal colon. Consequently, the surface area of colonic mucosa exposed to urine is decreased and the rate of reabsorption is limited.

Toward a Standardized System for Reporting Surgical Outcome of Pediatric and Adolescent Live Donor Renal Allotransplantation

PURPOSE There is a lack of a standardized reporting methodology for surgical complications of pediatric renal transplantation. We applied Martin criteria and the modified Clavien-Dindo classification in pediatric renal transplantation. MATERIALS AND METHODS We retrospectively reviewed the charts of 447 patients 20 years or younger who underwent renal transplantation between March 1976 and January 2011. Martin criteria were fulfilled and complications were graded according to the modified Clavien-Dindo classification. For early complications grades I and II were considered low grade and III to V high grade. A similar grading system was adopted for late complications. RESULTS A total of 84 early complications (18.5%) occurred in 77 transplant recipients (17%). Of grade I complications 37 (8.1%) were asymptomatic lymphoceles. Grade II complications were observed in 2 patients (0.4%). Grade IIIa complications included aspiration of hematoma (1 case), percutaneous nephrostomy fixed for ureteral obstruction (3), percutaneous tube drain for symptomatic lymphoceles (7) and antegrade ureteral stenting for ureteral leakage (6). Grade IIIb complications included exploration for wound dehiscence (1 case), revision of ureterovesical anastomosis (8), marsupialization of lymphoceles (4), hemorrhage (3) and vascular thrombotic accidents (6). Graft nephrectomy (grade IVa) complications occurred in 2 transplant recipients. Among 4 mortalities (grade V) only 1 patient died due to surgical complications. On multivariate analysis delayed graft function was the only predicator of high grade surgical complications (p = 0.005). High grade surgical complications affected recipient but not graft survival. CONCLUSIONS Using a standardized, high quality reporting methodology is feasible in pediatric renal transplantation. However, consensus should be sought regarding medical complications and a grading system should be developed for reporting of late complications.

Pomegranate protects liver against cecal ligation and puncture-induced oxidative stress and inflammation in rats through TLR4/NF‐κB pathway inhibition

Acute liver injury secondary to sepsis is a major challenge in intensive care unit. This study was designed to investigate potential protective effects of pomegranate against sepsis-induced acute liver injury in rats and possible underlying mechanisms. Pomegranate was orally given (800mg/kg/day) for two weeks before sepsis induction by cecal ligation and puncture (CLP). Pomegranate improved survival and attenuated liver inflammatory response, likely related to downregulation of mRNA expression of toll like recptor-4, reduced nuclear translocation and DNA binding activity of proinflammatory transcription factor NF-κB subunit p65, decreased mRNA and protein expression of tumor necrosis factor-alpha and reduction in myeloperoxidase activity and mRNA expression. Pomegranate also decreased CLP-induced oxidative stress as reflected by decreased malondialdehyde content, and increased reduced glutathione level and superoxide dismutase activity. These results confirm the antiinflammatory and antioxidant effects of pomegranate in CLP-induced acute liver injury mediated through inhibiting TLR4/NF-κB pathway, lipid peroxidation and neutrophil infiltration.

A Prospective Randomized Study of the Portective Effect of Verapamil on the Ischaemic Renal Injury in Renal Allotransplants

The objective of this work was to study the possible protective effect of verapamil against the ischaemic acute tubular necrosis in kidney transplantation.

Pretransplant Mixed Lymphocyte Culture Still Has an Impact on Graft Survival

Background/Aim: Mixed lymphocyte culture (MLC) is an important in vitro test for studying allograft reaction. The recipient-donor MLC reflects donor specific hypo- or hyperimmune response. The various studies have been correlated donor-specific MLC reactivity with graft survival in cadaver kidney transplantation. This retrospective study reports the relationship between of MLC hyper-responsiveness and graft survival in living-donor kidney transplantation. Methods: The study included 477 patients who underwent live-donor kidney transplantation between Marsh 1976 and January 2002. They were divided according to the relative response (RR) of pre transplant one way MLC into hypo responders (RR <4) and hyper responders (RR >4). The demographic and follow-up data for both groups were recorded. The duration of follow-up ranged from 44 to 84 months. Results: The two groups were homogenous regarding age, sex, donor source, HLA-A, B-and -DR mismatches, number of blood transfusion and type of 3 primary immunosuppressions. Acute rejection (AR) episodes were seen in 182 (44.8%) patients in the hypo-responders group, of whom 10 were steroid resistant, while in the hyper-responder recipients, AR episodes occurred in 33 patients (46.5%) of whom 5 patients (15.2%) were steroid resistant (p < 0.05). Chronic allograft nephropathy occurred in 14.5% and 27.3% and the actuarial 5-year graft survival was 79% and 60% (p = 0.03).in the hypo- and hyper-responder groups, respectively. Conclusions: It is concluded that MLC reaction may predict high-risk patients for immunological graft failure and that more potent immunosuppression should be considered in MLC hyper-responders.