Fayez T. Hammad

Pediatric Extracorporeal Shockwave Lithotripsy: Its Efficiency at Various Locations in the Upper Tract

BACKGROUND Several reports demonstrated the effectiveness of extracorporeal shockwave lithotripsy (SWL) in the management of pediatric upper tract urolithiasis. The majority of these studies used the stone-free rate as the main indicator for treatment success. Efficacy Quotient (EQ) is an important outcome measure because it not only takes into consideration the stone-free rate, but also includes other undesirable outcomes that increase patient morbidity and utilizes hospital resources. Nevertheless, very few studies reported on the EQ of pediatric SWL at various locations in the upper tract. METHODS We retrospectively reviewed the records of 84 children (103 urinary calculi) who were treated with SWL in our institution between 1995 and 2005. RESULTS There were 84 renal (pelvis, n = 27; upper calyx, n = 13; middle calyx, n = 8; lower calyx, n = 36) and 19 ureteric (upper third, n = 10; middle third, n = 5; lower third n = 4) stones. EQ for renal pelvic stones was 67% compared to 48% for caliceal stones (upper calyx: 52%, middle calyx: 46% and lower calyx: 47%). Overall, the EQ for renal stone was 54% and it was 59% for ureteric stones. This efficiency in the ureter was achieved at the expense of a higher number of shock waves delivered (3606 vs. 2592, P < 0.01). Overall, the stone-free rate was 82% (renal, 81%; ureteric calculi 84%). The only factor that affected the stone-free rate was the size of the stone (33% in stones >2 cm and 87% in stones <2 cm (P < 0.01). The overall retreatment rate was 41% (renal, 40% and ureteric 42%). However, the number of total treatments ranged from 1 to 5 sessions in renal stones and 1 to 2 sessions in ureteric stones. Auxiliary procedures were performed in 9 patients (stenting, n = 3; ureteroscopy, n = 4 and percutaneous nephrolithotomy, n = 2). CONCLUSIONS Pediatric SWL appears to be more efficient in the renal pelvic stones compared to caliceal stones. The efficiency of SWL in the ureter is achieved with a higher number of shock waves delivered. A discussion on the possible future modifications of the definition of EQ, especially in children, is also provided.

TVT can also cause urethral diverticulum.

Since the introduction of tension-free vaginal tape (TVT) procedure by Ulmsten, the majority of reports have concentrated on TVT procedure’s success to correct urinary stress incontinence with fewer reports on its complications. In this study, we describe the first case in the English literature, of urethral diverticulum, which occurred after the use of polypropylene synthetic sling in a woman with previous vaginal surgery.

The Effect of Fat and Nonfat Components of the Skin-to-Stone Distance on Shockwave Lithotripsy Outcome

BACKGROUND Few studies have addressed the effect of skin-to-stone distance (SSD) on the success of extracorporeal shockwave lithotripsy (SWL). Nevertheless, the effect of the two components of SSD, that is, the fat SSD (FSSD) and nonfat SSD (NFSSD) components, was not previously investigated. METHODS In this prospective study, all patients (n = 113) who had single radio-opaque kidney stones and underwent SWL for the first time between January 2006 and June 2007 were recruited. SSD, FSSD, and NFSSD were measured by noncontrast CT scan at 0°, 45°, and 90° and the average was calculated. The outcome was defined as successful (completely stone free or residual fragments ≤ 3 mm) or unsuccessful (residual fragments > 3 mm or complete failure of fragmentation). RESULTS Sixty-nine (61%) patients had successful treatment. On univariate analysis, SSD, FSSD, and NFSSD were significantly lower in the successful group compared with those with unsuccessful outcome (71.9 ± 13.3 vs. 86.2 ± 25.1 mm [p = 0.001], 27.2 ± 10.3 vs. 36.1 ± 17.3 mm [p = 0.011], and 44.7 ± 7.2 vs. 50.1 ± 13.9 mm [p = 0.02], respectively). The muscle component of the NFSSD was also lower in the successful group (21.5 ± 4.1 vs. 25.2 ± 10.0 mm [p = 0.01]). On multivariate analysis, factors that independently predicted treatment success were SSD, stone attenuation, and stone size but not the FSSD or NFSSD. CONCLUSIONS Although the total SSD appeared to be a significant predictor of SWL success, its fat and nonfat components did not independently predict the final outcome and only appeared to be important through their contribution to the total SSD.

Social impact and healthcare-seeking behavior among women with urinary incontinence in the United Arab Emirates

To determine the prevalence and social impact of urinary incontinence (UI) and healthcare‐seeking behaviors among women in the United Arab Emirates (UAE).

Propagation of the Electrical Impulse in Reversible Unilateral Ureteral Obstruction as Determined at High Electrophysiological Resolution

PURPOSE We investigated the propagation of electrical impulses in a reversible, complete or partial unilateral ureteral obstruction model in vivo. MATERIALS AND METHODS In Wistar rats the left mid ureter was completely (8) or partially (7) occluded and released after 24 hours. We recorded electrical activity of the left and right ureter before, during and after obstruction at different stages up to 2 weeks after obstruction using a high resolution, 64 extracellular electrode probe. RESULTS Complete obstruction in the left proximal ureter caused an immediate increase in frequency from a mean ± SEM of 14.8 ± 1.3 to 18.6 ± 1.7 per minute (p <0.05), followed by a 1.4 ± 0.9 per minute decrease (p <0.001). Within the first 2 days after reversal velocity gradually decreased from 1.82 ± 0.12 to 0.79 ± 0.17 cm per second (p <0.001). Release of obstruction gradually restored frequency and velocity, which returned to baseline at 2 weeks. Generally the alterations in rats with complete and partial obstruction were similar but they were less marked in those with partial obstruction. Distal to the obstruction site the impulses disappeared (38%) or propagated retrograde (43%) at some stage in the post-obstruction period. These abnormal impulse propagations also gradually disappeared in the post-obstruction stage. CONCLUSIONS After complete or partial ureteral obstruction there were immediate, significant changes in the propagation of electrical impulses in the proximal and distal left ureter, which were generally less marked after partial than after complete obstruction. Reversal of obstruction resulted in the gradual disappearance of this abnormality in 2 weeks.

The role of urologists in the management of urological injuries during obstetric and gynaecologic surgery

Introduction and hypothesisWe investigated the role of urologists in the management of urological injuries (UI) during obstetric and gynaecological (Ob&Gyn) surgery in a setup where endourological facilities were available intraoperatively.MethodsWe retrospectively reviewed all such cases between January 2000 and December 2005.ResultsOut of 13,010 procedures, urologists were involved in 98 patients (prophylactic ureteric stenting (n = 29) and involvement after the occurrence or suspicion of UI (n = 69)). There were 43 injuries (bladder, n = 32; ureter, n = 11). Four bladder and 10 ureteric injuries were only identified using endourological procedures. The incidence of UI in caesarean sections (lower segment caesarean sections (LSCS)) was higher than other procedures (0.46% vs. 0.19%, P < 0.01). There was no difference in the incidence of injuries in emergency vs. elective LSCS (0.42% vs. 0.65%, P = 0.24).ConclusionsThe availability of endourological facilities in the Ob&Gyn operating room facilitated the identification and management of UI especially ureteric injuries.

Expression of Wilms tumor-1 protein and CD 138 in malignant mesothelioma of the tunica vaginalis

Malignant mesothelioma (MM) of the tunica vaginalis is a very rare tumor which can be difficult to diagnose histologically. We report an 83-year-old patient with MM of tunica vaginalis of the left testis. To the best of our knowledge, this is the first reported case of MM of the tunica vaginalis expressing Wilms tumor-1 protein, CD138, the expression of which could help in confirming the histopathological diagnosis and in targeting therapy.

Development and validation of an Arabic version of the International Prostate Symptom Score

To develop and validate an Arabic version of the International Prostate Symptom Score (IPSS).

Intra- and post-operative assessment of renal cortical perfusion by laser Doppler flowmetry in renal transplantation in the rat.

Renal blood flow (RBF) in the period immediately following transplantation has an important prognostic value. Here we report for the first time on the use of laser Doppler flowmetry (LDF) for the measurement of renal cortical perfusion (RCP) during all the important steps in renal transplantation. Left orthotopic kidney transplantation was performed in Lewis rats (n = 14) after 2 h of cold ischaemia and preservation in EuroCollins solution. Under baseline conditions, RCP in the donor and recipient kidneys were similar with a coefficient of variability of 11 and 12%, respectively. There was a progressive increase in RCP during the first 60 min after transplantation with a return to normal values 2 weeks later. In conclusion, LDF provides a rapid and continuous measure of RCP without interference to the operative site and may prove a useful tool for the measurement of RBF during kidney transplantation.

Propagation characteristics of the electrical impulse in the normal and obstructed ureter as determined at high electrophysiological resolution: ELECTRICAL IMPULSES PROPAGATION IN URETERIC OBSTRUCTION

What’s known on the subject? and What does the study add?