Mohamed El-Azab

Emphysematous pyelonephritis : A 15-year experience with 20 cases

OBJECTIVES To review our experience with emphysematous pyelonephritis over the past 15 years. METHODS Twenty patients with emphysematous pyelonephritis were reviewed regarding diagnosis, treatment, and outcome. RESULTS Women outnumbered men (75% versus 25%), and 80% of patients were diabetic. The left kidney was more frequently affected than the right one (60% versus 35%) and both kidneys were involved in 5%. Obstruction of the corresponding renoureteral unit was found in all the nondiabetic and in half of the diabetic patients. Diagnosis was confirmed by gas in the parenchyma or perinephric space by plain x-ray of the abdomen or computed tomography. Escherichia coli was the most common organism; it was found in 70% of urine cultures. A prompt attempt to control diabetes was made, and intravenous antibiotics were given. Nephrectomy was immediately performed after stabilization of the general condition of the patients. A total of 80% of patients survived the procedures. CONCLUSIONS For successful management of emphysematous pyelonephritis, appropriate medical treatment should be attempted but immediate nephrectomy should not be delayed.

Surgical complications following radical cystectomy and orthotopic neobladders in women.

PURPOSE Orthotopic neobladders have become the standard of care after radical cystectomy in select women with bladder cancer. We report early and late complications in 192 patients. Although medical complications were important, they were not the focus of this study. MATERIALS AND METHODS Between January 1995 and December 2003, 192 women with a mean age of 50.6 years received an orthotopic neobladder after radical cystectomy for bladder cancer. Standard radical cystectomy was done. Ileal reservoirs were used, mostly in the form of an ileal W-neobladder. We evaluated the patients for functional outcome, early and late complications, and treatment for these complications. RESULTS Two patients (1%) died of pulmonary embolism 1 to 2 weeks after cystectomy. Followup was 6 to 125 months (mean 54). Early complications included hemorrhage requiring reexploration in 1 case, postoperative blood transfusion in 1, wound infection in 8, prolonged ileus in 5, deep vein thrombosis in 5, pouch-vaginal fistula in 6, prolonged urinary leakage in 3, pouch-cutaneous fistula in 1 and early ureteral obstruction in 1. Of the 177 patients eligible for functional evaluation 62 experienced a total of 75 late complications, including stone disease in 18, ureteroileal stricture in 19, reflux in 22, intestinal obstruction in 2, incisional hernia in 2 and chronic pyelonephritis in 12. Early and late complications were treated accordingly with good outcomes. CONCLUSIONS Early and late complications develop in a significant number of patients. Most early complications may be treated conservatively, while late complications are mostly treated with endourological and/or open surgery. Close lifelong surveillance of patients is mandatory to detect and properly treat these complications.

Magnetic resonance imaging as a sole method for the morphological and functional evaluation of live kidney donors

In this section, authors from Mansoura describe their experience with MRI as the sole method for the morphological and functional evaluation of live kidney donors. They recommend this technique in both instances.

Urological trauma after gynecological and obstetric surgeries

Objective Material and methods Gynecological and obstetric surgeries are not uncommon causes of iatrogenic injury of the urinary tract. Herein, we retrospectively report our experience with these injuries over the last 18 years. Results Between 1985 and 2003, 120 females (mean age 34.2±13.7 years) were included in this study. The types of injury were as follows: vesicovaginal fistula, n=90; ureterovaginal fistula, n=14, ureteric ligation, n=13, vesicouterine fistula, n=2; and ureterouterine fistula, n=1. Definitive repair of such injuries was performed in all cases, including 10 cases of recurrent vesicovaginal fistulae which were treated by means of augmentation cystoplasty or urinary diversion. All patients were evaluated regarding the time and type of surgical intervention and early and late postoperative complications, including failure of primary repair. Conclusions Of the 80 cases of vesicovaginal fistulae treated with definitive repair, 12 (13.3%) showed recurrence of the fistula. Early ureteric deligation and early or delayed ureteroneocystostomy or ureteric replacement were successful in all cases with ureteric injury. There was no loss of kidney function following the trauma or its repair. It is mandatory for gynecologists and obstetricians to pay careful attention to the anatomy of the urinary tract in order to avoid its iatrogenic injury. Endourologic means were successful in enabling first aid management of some of these injuries. Early exploration is indicated in cases of ureteric obstruction that present early after trauma. Augmentation cystoplasty, urinary diversion or ileal replacement are indicated in only a few cases.

Tunica albuginea acellular matrix graft for treatment of Peyronie's disease. An experimental study in dogs

Objective: To study the value of an acellular matrix graft of the tunica albuginea for reconstruction of the penis in cases of severe Peyronies disease. Material and Methods: In nine mongrel dogs, an acellular matrix graft of the tunica albuginea was used to cover a 30×10 mm 2 tunical defect. Equal numbers of animals were sacrificed at 1, 3 and 6 months after surgery. Before death, an erection was induced by means of papaverine injection and cavernosography was performed. After death the penis was prepared for histopathological study. Results: All animals survived the surgery and none developed haematoma, wound infections or dehiscence. All dogs developed a straight, rigid erection. Cavernosography showed patent corpora cavernosa in all animals. The papaverine injection and cavernosographic results did not change over time. Inspection of the graft site and measurement of its length and width showed healing with no contracture. Histologically, the regenerated matrix appeared thicker than the neighbouring tunica albuginea in the 1‐month group; otherwise the appearance was normal. Gradual orientation of the fibrocytes, capillaries and collagen fibres was demonstrated at 1 month and was complete at 3 and 6 months. Comparison between an implanted tunica at 6 months and a control tunica from a normal dog showed no significant histological difference. Conclusion: A homologous acellular matrix graft of the tunica albuginea may be an alternative treatment for severe cases of Peyronies disease.

Doppler Ultrasonography in Evaluation of Potential Live Kidney Donors: A Prospective Study

PURPOSE We compared the accuracy of Doppler ultrasonography and intra-arterial digital subtraction angiography for preoperative visualization of the number of renal arteries in potential live kidney donors. MATERIALS AND METHODS Intra-arterial digital subtraction angiography and Doppler ultrasonography were used to study the renal anatomy of 64 consecutive kidney donors. Doppler studies were performed without knowledge of the angiographic findings. All donors underwent nephrectomy, and the number of renal arteries at nephrectomy was compared with that predicted by intra-arterial digital subtraction angiography and Doppler ultrasonography. RESULTS One renal artery was found in 53 harvested kidneys, 2 in 10 and 3 in only 1. Analysis of the data revealed sensitivity 96.2% and specificity 100% for intra-arterial digital subtraction angiography versus sensitivity 100% and specificity 60% for Doppler ultrasound. Overall accuracy was 96.8% for angiography versus 93.7% for Doppler ultrasound, compared to 96.2 and 100%, respectively, for single, and 100% and 60%, respectively, for double renal arteries (p < 0.03). Both tests were interpreted as showing double vessels in the case with triple renal arteries. CONCLUSIONS Although Doppler ultrasonography is accurate in delineation of single renal arteries, its limited ability to identify multiple arteries should make one cautiously optimistic regarding its current use.

Prostatic Abscess in a Child

We report a metastatic prostatic abscess in a 12-year-old boy. Rectal examination revealed a tender, fluctuating prostatic mass, causing acute retention of urine. Prostatic imaging by computerized tomography and transrectal ultrasonography were important in the diagnosis and management.