Ahmed Shahat

The use of small intestinal submucosa graft for hypospadias repair: Pilot study

Abstract Objective: To evaluate the outcome of using commercially available (SIS) grafts for repairing hypospadias. Collagen-based acellular matrices, including SIS and bladder submucosa matrix, have been used to repair urethral strictures, with varying success, and patients with hypospadias and with inadequate or no genital skin need a substitute tissue for urethroplasty. Patients and methods: This pilot study included 12 patients (mean age 8 years, range 1.5–15) with hypospadias (distal in six, mid-shaft in four and proximal in two). They underwent a repair with four layers of prefabricated SIS as an onlay graft. The outcome was assessed for cosmetic appearance, urinary stream and the postvoid residual volume. The chi-squared and Mann–Whitney U-tests were used to assess the relationship between preoperative factors and the outcome of the repair with SIS grafting. Results: The mean (range) follow-up was 23 (6–36) months. Nine patients ultimately voided normally, with a good cosmetic appearance and no postvoid residual urine. Six patients had a successful repair with no further intervention, whilst three had small fistulae that were treated by simple closure. In three patients the graft failed, by complete disruption or stricture. Graft infection adversely affected the outcome of SIS grafting. Conclusions: The prefabricated SIS graft can be used as an alternative substitute for urethral reconstruction when genital skin is insufficient or lacking, as in circumcised patients or a repeat hypospadias repair. Graft infection is the chief reason for graft failure and should be prevented. Further studies with more patients are needed to confirm these preliminary results.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children

Objectives: The study aimed to present our center’s experience with long-standing urethral stones in male children with normal urethra. Materials and Methods: Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 – June 2016. Demographic and clinical data were studied. Results: Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. Conclusions: Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach.

Is Concealed Epispadias a Rare Variant

OBJECTIVE To present our experience with concealed epispadias and to estimate its actual share in the isolated male epispadias cases and its effect on the surgical outcome. MATERIALS AND METHODS Consecutive patients with isolated male epispadias treated in our center between 2008 and 2015 were classified into concealed and classic epispadias. The 2 groups were compared regarding age at presentation, meatal location, incontinence, dorsal curvature, success rate, and complications. RESULTS Out of 51 patients with isolated male epispadias, 11 (21.6%) were concealed: 7 balanic and 4 penile shaft epispadias. Concealed epispadias cases were found to have significantly delayed age at presentation, more distal meatal location, and less incontinence rate than classic epispadias cases. None of the surgical outcome parameters showed significant difference between the 2 groups. CONCLUSION Concealed epispadias represents about one-fifth of isolated male epispadias cases. Impediment and delay of diagnosis are its main clinical impacts, with insignificant effect on the surgical outcome.

MP44-20 PERSISTENT VESICOURETERAL REFLUX AFTER ILEOCECAL CYSTOPLASTY IN CHILDREN WITH VOIDING DYSFUNCTION

Objectives: To define incidence, risk factors and effect of persistent vesivoureteral reflux [VUR] after ileocecal cystoplasty in children with voiding dysfunction. Materials and methods: Between June 2008 and June 2013, children 5-18 years old, who had VUR before ileocecal cystoplasty without ureteral reimplantation, were included. Voiding cystourethrogram and pressure flow study were obtained before and 6-12 months after the operation. VUR was graded using the international reflux study committee classification. Grades I, II, and III were considered low grade. Grades IV and V were considered high grade. VUR persistence was analyzed in relation to age, sex, cause of voiding dysfunction, laterality, preoperative and postoperative maximum detrusor filling pressure, and preoperative grade of reflux. Attacks of febrile acute pyelonephritis were recorded and analyzed in relation to VUR persistence. Follow up period ranged from 12 to 55 months [mean 34.1]. Results: 25 refluxing renal units in 13 children [8 males and 5 females] were included. Age range was 6-16 years [mean 11.06]. The cause of voiding dysfunction was neurogenic in 8, dysfunctional voiding in 3, and valve baldder in 2. All of them had ileocecal cystoplasty with enforced in-situ appendicular catheterizable stoma. VUR was low grade in 4 renal units and high grade in 21. Postoperative low grade VUR was found in 13 renal units (52%), and no high grade VUR. Preoperative high grade reflux was significantly related to VUR persistence (Chi-square, p=0.023). Mean preoperative maximum detrusor filling pressure with persistent reflux was 61.1 ±5.8 cmH2O, and 72.1 ±10.3 cmH2O with cured reflux (t-test, p=0.003). 8 renal units in 6 patients had attacks of acute pyelonephritis. Persistent VUR was in 6 of them (Chi-square, p=0.007). Conclusions: Preoperative high grade VUR and low maximum detrusor filling pressure are risk factors for persistent VUR after ileocecal cystoplasty in children. Persistent VUR is a risk factor for acute pyelonephritis and may have a deleterious effect on the kidney. Published In: NULL , NULL , ودنلاروأ ىف دقعنملاو ةيعمجلا رمتؤملا Powered by TCPDF (www.tcpdf.org) page 1 / 1