Mahmoud Mustafa

Bladder erosion of tension-free vaginal tape presented as vesical stone; management and review of literature

The vesical stone formation due to intravesical mesh erosion of tension-free vaginal tape (TVT) is rare. In this report, a case of 48-year-old patient who underwent (TVT) elsewhere is discussed. The patient was presented with vesical stone and persistent stress urinary incontinence. Intravesical stone was detected by non-contrast computed tomography and cystourethroscopy. Stone fragmentation was done by pneumatic lithotripsy and transurethral resection of the mesh was performed. The postoperative control cystoscopy demonstrated complete healing of bladder mucosa.

Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias

PurposeWe report a multicenter experience using double dartos flap to protect the neourethra in TIP urethroplasty for distal and midpenile hypospadias.MethodsA total of 394 patients underwent tubularized incised plate urethroplasty for primary distal and midpenile hypospadias using double dartos flap protection by ten pediatric surgeons and urologists at five different institutions.ResultsTubularized incised plate urethroplasty protected by a double dartos flap was simple to perform and flaps were easy to obtain. Complications occurred in 23 patients (5.83%): fistulas 1.01% (4 cases), stenosis 0.25% (1 case), mild stenosis 2.53% (10 cases), dehiscence of ventral cutis 0.50% (2 cases) and penile torsion 1.26% (5 cases). All fistulae had a spontaneous resolution.ConclusionDouble dartos flap to protect tubularized incised plate urethroplasty is safe with a low complication rate. The neourethra is covered entirely with a double layer of vascularized tissue and the double coverage appears a good choice for preventing urethrocutaneous fistula formation.

Erosion of an Intrauterine Contraceptive Device through the Bladder Wall Causing Calculus: Management and Review of the Literature

Intrauterine contraceptive devices have been in use for more than 30 years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. A 46-year-old women is described in whom intravesical migration of the intrauterine device was complicated by bladder stone formation. Endoscopic management was applied with an excellent outcome.

Bilateral supernumerary kidneys in conjunction with horseshoe anomaly

Bilateral supernumerary kidney is a very rare urogenital anomaly, with four cases reported in the literature thus far. To the best of our knowledge, bilateral supernumerary kidney in conjunction with horseshoe fusion anomaly is not reported till date. Herein, we report a 63-year-old male patient with persistent lower abdominal pain. Complete radiological evaluation including ultrasound, computed tomography scan, excretory urography and retrograde pyelography were done and the diagnosis was established. The dilemma faced in the diagnosis and management of patients with supernumerary kidneys is discussed.

Placard‐shaped in situ vaginal wall sling for the treatment of stress urinary incontinence

Purpose:  To evaluate the efficacy of a simple and economic procedure using a placard‐shaped in situ anterior vaginal wall sling for the treatment of stress urinary incontinence, with or without cystocele repair.

Is There an Association Between Serum Prostate-Specific Antigen Values and Serum Testosterone Levels in Healthy Men?

Purpose To evaluate the relationship between levels of total testosterone and total prostate-specific antigen (PSA) in healthy men with PSA<4 ng/mL. Materials and Methods The study comprised 179 men with a mean age of 59.19±12 years who visited Osmaniye State Hospital, Osmaniye, Turkey, between January 2006 and January 2007 for a routine checkup. The patients were divided into two subgroups: patients with PSA<2.5 mg/ml (group I, n=160 patients) and patients with PSA of 2.5 to 4 ng/mL (group II, n=19 patients). The relationship between PSA and testosterone levels was investigated in both groups and in patients aged <60 years. The mean testosterone level was calculated for patients aged <50 years and was compared with the mean value of patients aged ≥50 years. Results In all patients, the mean values for serum PSA and total testosterone were 1.27±0.88 ng/mL and 404.04±158.86 ng/mL, respectively. No correlation was detected between serum PSA and testosterone levels in either subgroup (group I, r=0.072, p=0.363; group II, r=0.031, p=0.900) or in patients aged <60 years (r=0.032, p=0.72). The mean values of testosterone in patients aged ≥50 years and in patients aged <50 years were 417.01±163.35 and 344.16±120.21 ng/dL, respectively (p=0.02). Conclusions No impact of testosterone was found on the PSA level in healthy men with PSA <4 ng/mL. Therefore, a high serum testosterone level may not mandate adjustment of PSA values. This serum sex hormone showed a significant increment after the age of 50 years. Further studies including a larger number of patients should be carried out to confirm these findings.

Dorsal Dartos Flap in Snodgrass Hypospadias Repair: How to Use It?

Purpose: To introduce new technique for covering neourethra with dorsal dartos subcutaneous tissue in Snodgrass hypospadias repair. Material and Methods: The study included 26 patients with primary hypospadias, aged 2–22 years (average 7.86), operated from June 2002 to August 2006. Of the patients, 21 had distal, 3 midshaft and 2 penoscrotal hypospadias. The standard technique of tubularized incised plate (TIP) with double-layer covering of the neourethra by subcutaneous tissue was used in all cases of reconstruction. The mean follow-up period was 4.5 months (range 3–12 months). Results: Successful result of a normal-looking penis without fistula was achieved in all patients. One patient had meatal stenosis (3.84%) at the early postoperative period which was corrected by urethral dilatation of the external meatus at an interval of up to 2 months postoperatively. Conclusion: Our technique represents a reasonable option for utilizing dorsal dartos subcutaneous tissue in TIP urethroplasty. The neourethra is covered symmetrically with a double layer of well-vascularized tissue and the penis is kept without rotation. Redundancy of the flap and its excellent vascularization depend on the harvesting technique. Further follow-up and a larger number of patients are needed before a final conclusion can be made

Aberrant vessels in ipsilateral malrotated kidney associated with contralateral cross ectopia without fusion

Aberrant vessels is the most common cause of extriensic uretero–pelvic junction (UPJ) obstruction. Due to the left flank pain, 18-year-old male patient with UPJ obstruction due to aberrant vessels in left malrotated kidney and right renal cross ectopia without fusion, had been operated. Ureter was reconstructed and anastomosed anterior to the aberrant vessels after the Double-J-Stent has been placed. At the postoperative period there were improvements in the clinical symptoms and renal function. So, even in the later childhood surgical choice is still the acceptable treatment modality in such cases. To the best of our knowledge, although there are some papers about aberrant vessels which cause UPJ obstruction, there is no such a case with ipsilateral renal hydronephrosis due to aberrant vessels associated with contralateral renal cross ectopia without fusion.

Robotic or open radical prostatectomy after previous open surgery in the pelvic region.

Purpose We sought to evaluate the feasibility and safety of open or robotic radical prostatectomy (RP) after rectum, sigmoid, or colon surgery. Materials and Methods Sixty-four patients with a median age of 65 years (range, 46-73 years) who underwent RP after previous pelvic surgery were included. Twenty-four patients (38%) underwent robotic RP and 40 patients (62%) underwent open RP. Bilateral lymph node dissection and nerve preservation were performed in 50 patients (78%) and 35 patients (55%), respectively. Variables evaluated included demographic characteristics, perioperative complications, and functional and oncological outcomes. The median hospitalization and follow-up periods were 2 days (range, 1-12 days) and 21 months (range, 1-108 months), respectively. Results No conversions from robotic to open surgery were performed and there were no intraoperative complications. Surgical margins were positive in 13 patients (20%), seminal vesicle involvement was detected in 6 patients (9%), and lymph node involvement was found in 2 patients (3%). Postoperative complications included lymphocele in 1 patient, urethral stricture in 1 patient, and bowel obstruction and persistent bladder leakage in 2 patients. Eighty-eight percent of the patients were continent at 7 months and 80% of patients were able to achieve erection with or without medical aid. Conclusions Open or robotic RP can be done safely and effectively in patients who have previously undergone pelvic surgery. Although prior pelvic surgery of the large intestine was associated with increased morbidity, it should not be considered a contraindication for robotic or open RP.

Ethnopharmacological survey of medicinal plants practiced by traditional healers and herbalists for treatment of some urological diseases in the West Bank/Palestine

BackgroundThroughout history, every civilization in the world used plants or their derivatives for treatment or prevention of diseases. In Palestine as in many other countries, herbal medicines are broadly used in the treatment of wide range of diseases including urological diseases. The main objective of this research is to study the use of herbal remedies by herbalists and traditional healers for treatment of various urological diseases in the West Bank regions of Palestine and to assess their efficacy and safety through the literature review of the most cited plants.MethodThe study included a survey part, plant identification and a review study. The first part was a cross-sectional descriptive study. Face to face questionnaires were distributed to 150 traditional healers and herbalist in all regions of the West Bank of Palestine. The literature review part was to assess the most cited plants for their efficacy and toxicity.ResultsOne hundred forty four herbalists and traditional healers accepted to participate in this study which was conducted between March and April, 2016. The results showed that 57 plant species belonging to 30 families were used by herbalists and traditional healers for treatment of various urinary tract diseases in Palestine. Of these, Apiaceae family was the most prevalent. Paronychia argentea, Plantago ovata, Punica granatum, Taraxacum syriacum, Morus alba and Foeniculum vulgare were the most commonly used plant species in the treatment of kidney stones, while Capsella bursa-pastoris, Ammi visnaga and Ammi majus were the most recommended species for treatment of urinary tract infections and Portulaca oleracea used for renal failure. In addition Curcuma longa and Crocus sativus were used for enuresis while Juglans regia, Quercus infectoria, Sambucus ebulus and Zea mays were used for treatment symptoms of benign prostate hyperplasia. Fruits were the most common parts used, and a decoction was the most commonly used method of preparation. Through literature review, it was found that Paronychia argentea has a low hemolytic effect and contains oxalic acid and nitrate. Therefore, it could be harmful to renal failure patients, also Juglans regia, Quercus infectoria and, Sambucus ebulus are harmful plants and cannot be used for treatment of any disease.ConclusionsOur data provided that ethnopharmacological flora in the West Bank regions of Palestine can be quite wealthy and diverse in the treatments of urinary tract diseases. Clinical trials and pharmacological tests are required evaluate safety and efficacy of these herbal remedies.