Mohamed Abdel-Khalek

Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones--a multivariate analysis model.

Objectives: To define prognostic factors that affect the success rate after extracorporeal shock‐wave lithotripsy (ESWL) of renal calculi and to estimate the probability of stone‐free status using a regression analysis model. Material and Methods: Between February 1992 and February 2002, 2954 patients with single or multiple radiopaque renal stones (<30 mm) underwent ESWL monotherapy. The results of treatment were evaluated after 3 months of follow‐up. Treatment success was defined as complete clearance of the stones with no residual fragments. The stone‐free rate was correlated with stone features and patient characteristics using the χ 2 test. Factors found to be significant using the χ 2 test were further analyzed using multivariate regression analysis. Results: At 3‐month follow‐up, the overall stone‐free rate using ESWL monotherapy was 86.7%. Failure to disintegrate the stones was observed in 7.3% of cases (n = 216) and failure to clear the fragmented stones occurred in 6% (n = 177). Repeat ESWL was needed in 53% of cases. Static steinstrasse occurred in 4.9% of cases (n = 146) and post‐ESWL auxiliary procedures were required in 4% (n = 118). Using the χ 2 test, patient age (p < 0.001), stone size (p < 0.001), location (p < 0.001), number (p < 0.001) and nature (p = 0.003), radiological renal picture (p < 0.001) and congenital renal anomalies (p < 0.001) had a significant impact on the stone‐free rate. Multivariate analysis excluded stone nature from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone‐free status after ESWL. The sensitivity of the model was 83%, the specificity 91% and the overall accuracy 87%. Conclusion: Patient age, stone size, location and number, radiological renal features and congenital renal anomalies are prognostic factors determining stone clearance after ESWL of renal calculi. Our regression model can predict the probability of the success of ESWL with an accuracy of 87%.

Predictors of prostate cancer on extended biopsy in patients with high-grade prostatic intraepithelial neoplasia: a multivariate analysis model.

To define the importance of extended biopsy in patients with high‐grade prostatic intraepithelial neoplasia (HGPIN) and to define predictors of cancer in extended biopsy in patients with HGPIN, using multivariate analysis.

Prognostic factors for extracorporeal shock-wave lithotripsy of ureteric stones--a multivariate analysis study.

Objective: To define factors that have a significant impact on the stone‐free rate after extracorporeal shock‐wave lithotripsy (ESWL) of ureteric stones using multivariate analysis. Material and Methods: Between February 1992 and February 2002, a total of 938 patients with ureteric stones were treated with in situ ESWL using the Dornier MFL 5000 lithotripter. The outcome of treatment was evaluated after 3 months and failure was defined as the presence of any residual stones. The stone‐free rate was correlated with patient characteristics (age, sex and radiological renal picture) and stone features (site, side, length, width, nature, opacity and the presence of ureteral stents). Factors with a significant impact on the stone‐free rate using the χ 2 test were further analyzed using multivariate analysis. Results: Overall, the stone‐free rate was 88.7%. Repeat treatment was required in 50.4% of cases. Post‐ESWL complications were observed in 32 cases (3.4%), including static steinstrasse in 19 (2%). Auxiliary procedures were needed in 28 cases (3%). Using the χ 2 test, only three factors had a significant impact on the stone‐free rate, namely stone site, the transverse diameter of the stone and the presence of a ureteral stent. The stone‐free rate was highest for stones located in the lumbar ureter (436/470; 92.8%) and lowest for those located in the pelvic ureter (268/324; 82.7%) (p = 0.0017). Stones with a transverse diameter of ≤1 cm were associated with a stone‐free rate of 89.7% (715/797), compared to 83% (114/141) for those with a transverse diameter of >1 cm (p = 0.017). Non‐stented patients had a stone‐free rate of 89.8% (732/815), compared to 81.3% (100/123) for stented patients (p = 0.006). On multivariate analysis, these three factors maintained their statistical significance. A logistic regression model was designed to estimate the probability of stone‐free status after ESWL. Conclusion: The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.

Extracorporeal shock wave lithotripsy in anomalous kidneys: 11-year experience with two second-generation lithotripters

OBJECTIVES To present our experience with extracorporeal shock wave lithotripsy (ESWL) in patients with anomalous kidneys and to determine the factors that may influence the stone-free rate in such patients. METHODS From February 1989 to February 2000, 198 patients were treated for urolithiasis in anomalous kidneys using ESWL. The mean patient age (SD) was 40.48 (11.53) years. The kidneys were horseshoe in 49 (24.7%), malrotated in 120 (60.6%), and duplex in 29 (14.7%). All patients were treated on an outpatient basis using two second-generation lithotripters (Dornier MFL 5000 and Toshiba Echolith). Pretreatment auxiliary measures were required in 6 patients (3%). Follow-up data were recorded at 3 months. The statistical analysis was performed using the chi-square and Mann-Whitney U tests, with differences considered statistically significant if P <0.05. RESULTS The mean stone length (SD) was 13.54 (5.49) mm. The stones were single in 148 (74.7%), of new onset in 155 (78.3%), and on the right side in 82 (41.4%). All stones, but 5 (2.5%), were radiopaque. The overall stone-free rate was 72.2%. Neither the type of renal anomaly nor the type of lithotripter had any impact on the stone-free rate (P >0.05). Stone burden (length and number) had a significant influence on the stone-free rate (P <0.05). No extraordinary complications were recorded. Steinstrasse developed in 7 patients (3.5%). No deterioration of renal function or configuration was detected. CONCLUSIONS ESWL is safe and reliable for treatment of urolithiasis in anomalous kidneys. It should be the primary therapy when the stones are less than 20 mm. The ESWL outcome is comparable for normal and anomalous kidneys when the calculus size is considered.

Extracorporeal shock-wave lithotripsy monotherapy of partial staghorn calculi : Prognostic factors and long-term clinical results

Objective. To define factors affecting the success and long-term outcome of extracorporeal shock-wave lithotripsy (ESWL) monotherapy of partial staghorn calculi. Material and methods. We retrospectively reviewed 92 patients with partial staghorn calculi who were treated with ESWL monotherapy. The outcome of the treatment was evaluated after 3 months. Long-term follow-up data (>24 months) were available for 49 patients. These data were further analyzed to determine long-term outcome. Results. At 3 months, the overall stone-free rate was 59.8%. Multiple ESWL sessions were required in 85.8% of patients. Stone surface area >500 mm2 was the only factor that significantly decreased the stone-free rate. Post-ESWL complications occurred in 12 patients (13%), among whom renal obstruction was observed in 10.8%. Secondary procedures were needed in 17 cases (18.4%). After a mean follow-up period of 7.5 years, the stone-free rate was 59.2% (29/49) and one-third of patients developed recurrence. In the long term, clinically insignificant residual fragments (CIRFs) passed spontaneously in 23% of patients, remained stable in 38.5% and became bigger in 38.5%. Regrowth of CIRFs was related to a history of stone recurrence. No patients showed deterioration of kidney function on the treated side and an improvement in pre-ESWL hydronephrosis was observed in 73.3% of patients. Conclusions. ESWL is suitable for staghorn stones ≤500 mm2. In the long term, CIRFs became bigger and required secondary intervention in one-third of patients. A history of stone recurrence is a significant predictor of regrowth of CIRFs. ESWL provides long-term preservation of function of the treated kidneys; however, one-third of patients develop recurrence.

A 4-year follow-up of a randomized prospective study comparing transurethral electrovaporization of the prostate with neodymium: YAG laser therapy for treating benign prostatic hyperplasia.

The Department of Urology and Nephrology in Mansoura, Egypt has turned their attention to many facets of urological practice in a thorough and interesting way. They have been involved in several technological treatments for LUTS in recent years, and here they describe a 4‐year follow‐up study where patients were randomized to Nd:YAG laser treatment or TUVP. They confirmed the view that TUVP is associated with effective and durable results, whereas the laser treatment was not.

Is transition zone biopsy valuable in benign prostatic hyperplasia patients with serum prostate-specific antigen >10 ng/ml and prior negative peripheral zone biopsy?

Objectives To evaluate the importance of transition zone (TZ) biopsy in benign prostatic hyperplasia (BPH) patients with serum prostate-specific antigen (PSA) >10 ng/ml and prior negative peripheral zone (PZ) biopsy and to estimate the sensitivity of TZ biopsy. Material and methods A total of 273 BPH patients with PSA >10 ng/ml and prior negative PZ biopsy underwent an extended biopsy protocol. In patients with a TZ volume <25 cm3, four TZ biopsies were taken (two cores per side from the apex and base). In patients with a TZ volume ≥25 cm3 (n=183), six TZ biopsies were taken (three cores per side from the apex, middle and base). Overall, 215 patients were subjected to either transurethral resection of the prostate (n=162) or open enucleation of the adenoma (n=53). Results The extended biopsy revealed prostate cancers in 21.2% of cases (58/273). The zonal distribution of the positive cores was as follow: PZ cancers only in 67.2% of cases (39/58), TZ cancers only in 13.8% (8/58) and PZ+TZ cancers in 19% (11/58). Overall, 73.6% (14/19) and 36.8% (7/19) of TZ cancers were detected at the apex and middle of the TZ, respectively, while no TZ cancers at all were detected at the base (p=0.00015). The incidence of carcinoma on definitive pathology was 5.6% (12/215). Consequently, TZ biopsy detected only 61.3% (19/31) of TZ cancers. The incidence of pure TZ cancers was 7.3%. On the χ2 test, patient age, serum PSA, transrectal ultrasonography findings and PSA density did not correlate significantly with the detection rate of TZ cancer. Prostate volume (p=0.023), TZ volume (p=0.027) and PSA/TZ density (p=0.007) were predictive of TZ cancers. Conclusions Although TZ biopsy was the sole site of cancer in only 2.9% of cases (8/273), it improved the cancer detection rate by 14% in this selected group of patients. The majority (74%) of TZ cancers were detected at the apex site. TZ biopsy has a low sensitivity (61%).

Is extended 11-core biopsy valuable in benign prostatic hyperplasia patients with intermediate serum prostate-specific antigen (4.1–10 ng/ml) and prior negative sextant biopsy?

Objective: To evaluate the importance of extended 11-core biopsy in benign prostatic hyperplasia (BPH) patients with intermediate prostate-specific antigen (PSA; 4.1–10 ng/ml) and prior negative sextant biopsy. Material and Methods: A total of 381 BPH patients with intermediate PSA (4.1–10 ng/ml) and prior negative sextant biopsy underwent extended 11-core biopsy, which included conventional sextant biopsy in addition to five cores from three alternative sites. Two cores were taken from the right and left anterior horns of the peripheral zone (PZ), two from the right and left anterior transition zones (TZs) and one from the midline of the PZ. Overall, 315 patients were subjected to transurethral resection of the prostate (n=272) or open prostatectomy (n=43). Results: Repeat 11-core biopsy revealed prostate cancer in 66/381 cases (17.3%). The distribution of positive cores on repeat 11-core biopsy was as follows: sextant biopsy sites only in 50% of cases (33/66); alternative sites only in 31.8% (21/66); and sextant plus alternative biopsy sites in 18.2% (12/66). The anterior horn of the PZ was the most frequently positive alternative site (25/33; 75.8%), followed by the TZ (5/33; 15.2%), while the midline site was involved in 9% of cases (3/33). Eleven-core biopsy had a significantly better cancer detection rate compared to sextant biopsy when digital rectal examination was normal (p=0.009), prostate volume was in the range 30–50 cm3 (p=0.033) and PSA density was ≥0.15 (p=0.024). Six cancer cases out of 315 (1.9%) were diagnosed as a result of the definitive pathology. The sensitivity of 11-core biopsy was 91.6%, compared to 62.5% for sextant biopsy (p < 0.001). Conclusion: An extended 11-core biopsy protocol is valuable in BPH patients with intermediate PSA (4.1–10 ng/ml) and prior negative sextant biopsy as it significantly improved the overall detection rate in our study by 32% (p=0.019).

Complete Mesocolic Excision With Central Vascular Ligation in Comparison With Conventional Surgery for Patients With Colon Cancer – The Experiences at Two Centers

Purpose Revolutions have occurred over the last 3 decades in the management of patients with colorectal cancer. Most advances were in rectal cancer surgery, especially after the introduction of the total mesorectal excision (TME) by Heald. However, no parallel advances regarding colon cancer surgeries have occurred. In 2009, Hohenberger introduced a new concept trying to translate the survival advantages of TME to patients with colon cancer. This relatively new concept of a complete mesocolic excision (CME) with central vascular ligation (CVL) in the management of patients with colon cancer represents an evolution in operative technique. We performed a comparative study between CME with CVL and conventional surgery for patients with colon cancer at Italian and Egyptian cancer centers, considering surgical quality and clinical outcome. Methods Seventy-nine Egyptian patients underwent conventional surgery (non-CME group) while 52 Italian patients underwent CME with sharp dissection between the embryological planes and CVL of the supplying vessels (CME group). Results Significantly better results were observed in terms of lymph node yield (CME group: 22.5 vs. non-CME group: 12; P < 0.0001) and lymph node ratio (CME group: 0.03 vs. non-CME group: 0.22; P < 0.0001). Regarding surgical morbidity, no significant difference was noted (CME group: 2 vs. non-CME group: 5; P < 0.702). Conclusion CME appears to be a safe procedure when performed by experienced hands through proper embryological planes. It also provides a superior specimen, with a higher lymph node yield, which consequently affects the lymph node ratio. Eventually, CME with CVL should be increasingly adopted and studied more deeply.

Etiologic revelation and outcome of the surgical management of idiopathic granulomatous mastitis; An Egyptian centre experience.

INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that is confused with cancer. It usually affects women in child bearing age. The exact aetiology and pathogenesis are still unknown, and the optimal therapeutic modality has not yet been established. Treatment most frequently includes Antibiotics, corticosteroids and immunosuppressant, surgical excision, and even mastectomy. MATERIAL AND METHODS We studied a thirty cases diagnosed with IGM in our locality to find out the leading risk factors and the outcome of our surgical approach which involves excision of the lesion in continuity with duct system. Patients demographic data, history related to lactation and outcome were recorded. RESULTS All patients were parous women with history of previous breast feeding for all kids. Twenty-six patients (86.66%) had a history of early incomplete nursing care to the affected breast. After our surgical approach, Twenty eight (93.3%) patients showed fast recovery with no detectable recurrences in the median follow up period (18 months) with acceptable cosmoses. CONCLUSION History of breast feeding together with early failure of complete nursing from a single breast is the most important risk factors for development of IGM in young aged women. Surgery plays an important role in treating IGM, however, it should be directed towards excision of the present mass (s) together with the pathological and colonized duct system.