Medhat Ahmed Abdalla

The management of penile fracture based on clinical and magnetic resonance imaging findings.

Associate Editor
Michael G. Wyllie

Expression of cell cycle-associated proteins in non-muscle-invasive bladder cancer: Correlation with intravesical recurrence following transurethral resection

The objective of this study was to evaluate the expression patterns of cell cycle-associated proteins in newly diagnosed non-muscle-invasive bladder cancer (NMIBC) to clarify the significance of these proteins as prognostic predictors in 161 consecutive patients undergoing transurethral resection (TUR). Expression levels of 7 cell cycle-associated proteins, including Aurora-A, c-erbB2, cyclin-D1, Ki-67, p21, p27, and p53, in TUR specimens were measured by immunohistochemical staining. Of the 7 proteins, weak expression of p21 was significantly associated with the incidence of intravesical recurrence (P = 0.012). Univariate analysis identified expression level of p21, tumor size, T stage, and concomitant carcinoma in situ (CIS) as significant predictors for intravesical recurrence (P = 0.0053, 0.0014, 0.024, and 0.035, respectively). Of these, p21 expression, tumor size, and concomitant CIS appeared to be independently related to intravesical recurrence (P = 0.029, 0.025, and 0.016, respectively). Furthermore, there were significant differences in intravesical recurrence-free survival according to positive patterns of these 3 independent factors; that is, intravesical recurrence occurred in 17 of 72 patients who were negative for risk factor (23.6%), 30 of 57 positive for a single risk factor (52.6%), and 24 of 32 positive for 2 or 3 risk factors (75.0%). These findings suggest that consideration of expression levels of cell cycle-associated proteins, in addition to conventional parameters, would contribute to accurate prediction of intravesical recurrence following TUR of NMIBC. Moreover, combined evaluation of p21 expression, tumor size, and concomitant CIS might be particularly useful for further refinement of the outcome in predicting intravesical recurrence following TUR of NMIBC.

Posterior Sagittal Pararectal Approach With Rectal Mobilization for Repair of Rectourethral Fistula: An Alternative Approach

OBJECTIVES To present this clinical series to report our initial experience with our technique as an alternative approach for treatment of rectourethral fistulas (RUFs). RUFS are a devastating complication of the urinary tract. The most appropriate approach remains controversial. METHODS From March 2002 to August 2007, 8 patients with RUF were referred to our institution. The etiology of the RUF was a fractured pelvis in 2, radical prostatectomy in 1, transurethral resection of the prostate in 1, anterior bowel resection in 1, and a pull-through operation in 3. Of the 8 patients, 5 had undergone urinary diversion and 3 had undergone a previous repair that had failed. They were evaluated and treated using the posterior sagittal approach with rectal mobilization. The fistulas were excised, and both the urethra and rectum were repaired. The inferior half of the gluteus maximus muscle was used as barrier in 5 of the 8 patients. The operative and immediate and late postoperative complications were recorded. The clinical outcome was defined as success when the patients experienced no fecaluria or pneumaturia. RESULTS All 8 patients, with a mean age of 38.7 years, were completely cured of their RUF. The mean operative time was 290 minutes, and the mean blood loss was 637.5 mL. The median hospital stay was 18 days. Early postoperative complications included wound infection in 1 and deep vein thrombosis in 1 patient. One patient developed a late complication of urinary incontinence. CONCLUSIONS Our approach is safe, provides excellent exposure, and allows for dissection under direct vision. The gluteus maximus flap is a good, nearby flap that can be used with minimal host morbidity.

Expression of integrin proteins in non-muscle-invasive bladder cancer: significance of intravesical recurrence after transurethral resection

Study Type – Aetiology (case control)
Level of Evidence 3b

Evaluation of early endoscopic realignment of post-traumatic complete posterior urethral rupture

Introduction: to report our experience with 41 patients treated by early endoscopic realignment of complete post-traumatic rupture urethra. Materials and Methods: The study includes patients presented to our institute, between May 2004 and April 2009, with post-traumatic complete posterior urethral disruption. Preoperative retrograde urethrography, voiding cystourethrography and abdominopelvic CT were performed to evaluate the urethral defect length, the bladder neck competence, the prostate position, and the extent of the pelvic hematoma. Within the first week after trauma, antegrade and retrograde urethroscopy were performed to identify both urethral ends and insert urethral catheter. Patients were followed up by pericatheter retrograde urethrogram monthly postoperatively till catheter removal on disappearance of extravasation. Retrograde urethrography, voiding cystourethrography and urethroscopy were performed 1 month after the removal of the catheter. Follow-up abdominal ultrasound and uroflowmetry monthly till 6 months, bimonthly till 1 year, and every 3 months thereafter were encouraged. Urinary continence and postoperative erectile dysfunction were assessed by direct patient interview. Results: Forty one patients in the age group 17-61 years (mean 37.9) were treated. Patients were followed up for Conclusions: Early endoscopic realignment for complete posterior urethral rupture is a feasible technique with no or minimal intraoperative complications. The technique is successful as the definitive line of therapy in reasonable number of patients and seems to render further future interventions for inevitable urethral stricture easier.

Long-term Follow-up of Infantile Wilms Tumor Treated According to International Society of Pediatric Oncology Protocol: Seven Years' Follow-up

OBJECTIVES To report the long-term follow-up of patients with infantile Wilms tumor treated according to the International Society of Pediatric Oncology study 9 protocol. METHODS We retrospectively reviewed our medical reports for diagnosed WT in patients aged 6-12 months from January 2001 to January 2009. The clinical presentation, stage, operative details, pathologic findings, and outcomes for these infants were analyzed. We reviewed the charts of these patients throughout the whole disease course through long-term follow-up, paying particular attention to the details of the clinical presentation, stage at presentation versus postoperative stage, intraoperative findings, pathologic findings, and outcomes. RESULTS The records revealed 16 patients with a median age of 7.5 months. All patients had presented with an abdominal mass, and 25% had presented with abdominal pain and hematuria. Associated congenital anomalies were observed in 16.7% of the patients. A favorable histologic type was found in 91.7% of the patients and 8.3% had an unfavorable histologic type. The median follow-up period was 57 months. Postoperative complete remission was achieved in all patients who underwent surgery. Relapse developed in 1 patient. The 7-year disease-free survival rate was 93.8%, and the 7-year overall survival rate was 75%. CONCLUSIONS The long-term follow-up data using the International Society of Pediatric Oncology study 9 protocol revealed good outcomes. The protocol was a safe and an effective line of therapy, associated with decreased morbidity and improved survival. Also, the reduction in tumor volume resulted in easier surgical procedures, with no intraoperative complications.