Enmar Habib

Outcome of complete primary bladder exstrophy repair: Single-center experience

OBJECTIVE Reconstruction of bladder exstrophy remains a challenge. We evaluated our experience with complete primary repair in classic bladder exstrophy. METHODS A retrospective data review was conducted of bladder exstrophy patients presenting at our institution between May 2000 and September 2007. Fifty-one patients (21 females and 30 males) with classic bladder exstrophy were included. Age of presentation ranged from 24h to 14 months. Mean follow up was 3 years (1 month-7 years). Patients were evaluated for continence, upper tract dilatation and cosmetic result. RESULTS Eight patients (15.6%) had failed closures and six (11.7%) had fistulae. Evaluation of continence excluded 16 patients not followed up at our center. Thirty-seven percent were continent on clean intermittent catheterization after the age of 5 years. Patients became dry only after augmentation cystoplasty. Upper tract changes were mild during our study with all patients having normal serum creatinine. CONCLUSION Patients may require more than one procedure for reconstruction. In our series, augmentation was required to achieve acceptable dryness. Early promising results with dry intervals in young patients did not translate to continence in older patients.

Holmium Laser Enucleation of the Prostate: Initial Report of the First 230 Egyptian Cases Performed in a Single Center

OBJECTIVES To report our experience with the first 230 cases of holmium laser enucleation of the prostate (HoLEP) performed in a single center. METHODS A total of 230 cases of HoLEP were performed between June 2007 and June 2008. Mean age of patients was 69.8 +/- 10.3 years, and 21.3% of patients were either on anticoagulant or antiplatelet treatment. There was no limit for prostate size, with a mean prostate size of 86.5 +/- 65.4 g (range: 20-350 g). Follow-up was performed regularly at 1, 3, 6, and 12 months, assessing the Q(max), PVR, and International Prostate Symptom Score. RESULTS Weight of prostate chips retrieved after morcellation was 78.6 +/- 61.3 g (range: 10-350), with enucleation time 102.2 +/- 55.4 minutes and morcellation time 19.3 +/- 10.1 minutes, leading an estimated efficiency rate of 0.64 g/min. The rate of decrease in prostate volume and prostate-specific antigen was 90.8% and 82.5%, respectively. At 1 month, mean Q(max) increased from 7.7 +/- 2.3 to 25.8 +/- 10.1 mL/s (P <or=.001), mean PVR decreased from 171.3 +/- 126.3 to 41.6 +/- 45.7 mL (P <or=.001), and mean international prostate symptom score improved from 17.3 +/- 6.7 to 6.6 +/- 3.4 (P <or=.001). These improvements were sustained throughout a 12-month follow-up period. Temporary irritative symptoms were evident in 34.6% and stress urinary incontinence in 9%, both of which were self-limited on medical treatment and Kegel exercises, respectively. Only 1 patient with pancytopenia required blood transfusion and there was no case for transurethral resection syndrome. CONCLUSIONS HoLEP is a safe and an effective modern modality for the treatment of symptomatic BPH regardless of the gland size, with satisfactory clinical outcome.

Outcomes of Hypospadias Repair in Older Children: A Prospective Study

PURPOSE The American Academy of Pediatrics recommendation is to perform hypospadias repair at age 6 to 12 months. However, our patient population included a significant proportion of patients in adolescence and beyond undergoing primary repair. We report a comparison of outcomes in patients in different age groups. MATERIALS AND METHODS We prospectively report on patients with distal hypospadias who underwent primary repair at our institution during 7 months. Study parameters included age, degree of hypospadias, surgical technique and the complications rate. RESULTS A total of 61 patients were included in analysis. All cases underwent repair using the tubularized incised plate technique. More proximal hypospadias and different repair techniques were excluded from study. Patients were classified by age, including group 1-25 (40%) 6 months to 2 years old, group 2-17 (28%) 2.2 to 3.7 years old and group 3-19 (32%) 4 years old or older. Only 6 patients (9.8%) had postoperative complications and all were in groups 2 and 3. In group 2 there were 3 complications (17.6%), including loss of repair, meatal stenosis and hematoma in 1 case each. In group 3 there were 3 cases (15.8%) of postoperative fistula. The fistula incidence was higher in group 3 (p = 0.032). CONCLUSIONS Despite previous reports suggesting a much higher incidence of complications in older children the complication rate is within the acceptable range for infant hypospadias repair in some series. However, these complications were statistically significantly different between the older groups when compared with the recommended age group under American Academy of Pediatrics guidelines.

Pattern of clinical presentation of congenital anomalies of the kidney and urinary tract among infants and children

Congenital anomalies of the kidneys and urinary tract (CAKUT) comprise various entities of structural malformations that result from defects in morphogenesis of the kidney and/or urinary tract. These anomalies are the most commonly diagnosed malformations in the prenatal period and constitute the leading cause of end‐+stage renal disease (ESRD) in children, worldwide. This prospective study was performed to report the patterns of clinical presentation and diagnosis of infants and children with such malformations.

Assessment of recoverability of kidney function in children with obstructive calcular anuria: multicenter study.

OBJECTIVE Urolithiasis in children can cause considerable morbidity. Our aim was to evaluate the impact of intervention on the recoverability of kidney functions. MATERIALS AND METHODS This prospective study included 93 children (66 boys and 27 girls) with median age of 3 years (range 0-14). Inclusion criteria were presence of anuria, oliguria, serum creatinine >2 mg% and/or hyperkalemia ≥ 6 mmol/L. The mean duration of anuria or oliguria was (mean ± SE) 5.3 ± 0.4 days. On presentation, mean plasma creatinine was 6.5 ± 0.29 mg/dl with a mean estimated glomerular filtration rate (eGFR) of 14 ml/min and creatinine clearance (CC) of 8.24 ml/min. Dialysis was performed in 21 (22.6%) patients. When condition allowed, emergency surgery was performed. RESULTS Mean follow up was 1.5 years with compliance of 82%. At the end of treatment, 83% of patients had complete clearance of calculi. Mean plasma creatinine after treatment was 3.3 ± 0.35 mg/dl with an average GFR of 24.5 ml/min. After treatment renal function returned to normal in 57%, improved in 27% and deteriorated in 16% of children. Renal function recoverability rate was 94.6%. Chronic renal failure developed in 3 (3.2%) patients and 2 (2.2%) patients died. When absolute plasma creatinine concentration [P(cr)] improved 20-50% the eGFR and CC were doubled, and when improved 50-70% eGFR and CC tripled. Beyond 70% improvement in [P(cr)], eGFR and CC improved 7-8 times. Using Spearmans correlation, the mode of presentation and the type of management had a significant correlation with renal function outcome (P = 0.019 and 0.013 respectively). CONCLUSION Urgent management of calcular anuria both medically and surgically is the cornerstone for favorable outcome. The mode of presentation and the type of management are significant factors affecting final renal function outcome.

Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy

To compare outcomes of the mini‐percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children.

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study.

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.

Risk factors for urological complications following living donor renal transplantation in children

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.

A comparative study between holmium laser enucleation of the prostate and transurethral resection of the prostate: 12-month follow-up

Background This was a prospective randomized clinical trial to compare the safety and efficacy of holmium laser enucleation of the prostate and transurethral resection of the prostate for surgical treatment of patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Patients and methods From December 2009 to October 2010, 60 consecutive patients with lower urinary tract obstruction (LUTs) due to BPH were randomized to either surgical treatment with HOLEP (group 1, n = 30) or standard TURP (group 2, n = 30). Preoperative assessments included American Urological Association (AUA) symptom score, serum prostate-specific antigen, (SPSA), post-void residual urine volume (PVR), transrectal ultrasound (TRUS) and uroflowmetry. Perioperative parameters included total operating time, resected tissue weight, hemoglobin loss, presence or absence of blood transfusion, time of catheter removal and duration of hospital stay. Postoperative evaluations were conducted at one, three, six and 12 months. Results Patients in the HOLEP group had shorter catheterization time and hospital stay, but longer operating time. Mean hemoglobin loss was lower in the HOLEP group (0.900 ± 0.419 g/dl vs 1.157 ± 0.918 g/dl). The follow-up results up to 12 months regarding AUA symptom score, PVR urine volume and Qmax showed that both groups were comparable. Complications Complications were similar between the two procedures with no significant difference. Conclusion HOLEP proved to be a safe and highly effective technique for surgical treatment of bladder outlet obstruction due to BPH.

Adding neostigmine to morphine epidurally lessens the incidence of postoperative urine retention: A comparative study

Abstract Introduction Postoperative urine retention is a common problem faced with many epidurally administered drugs to relief pain. Morphine was introduced as a potent epidural analgesic, however; its administration is associated with a high incidence of urine retention. Neostigmine had been proposed as an epidural analgesic that lacks major side effects faced with intrathecal neostigmine. However, the effect of the combined use of both drugs upon lower urinary system has not been discussed. Methods 100 Patients allocated into 4 equal groups were subjected to inguinal hernia repair under epidural anesthesia. Group I received bupivacaine 10 ml 0.5%, Group II received bupivacaine/morphine 2 mg, Group III received bupivacaine/morphine 2 mg and 5 μg/kg neostigmine and Group IV received bupivacaine and 5 μg/kg neostigmine. Incidences of postoperative urine retention and patients who needed catheterization in each group were recorded. Mean arterial blood pressure, heart rate and incidence of complication (nausea, vomiting, pruritis, hypotension and bradycardia) were recorded. Time for 1st rescue analgesic drug was recorded. Results No single patient experienced urine retention in Group IV. Whereas one patient in both Groups I and III versus five patients in Group II suffered from urine retention and required urinary catheterization. The hemodynamic parameters were comparable between all groups. Time for 1st rescue analgesic drug was prolonged in Group III more than the other groups followed by Groups II, IV and I, respectively. Conclusion Addition of neostigmine to morphine epidurally lessened the incidence of postoperative urine retention commonly faced when morphine is used alone with local anesthetic and prolonged the duration of analgesia.