Mohamed Gaballah

Urethral Controlled Bladder Substitution: A Comparison between the Intussuscepted Nipple Valve and the Technique of Le Duc as Antireflux Procedures

A urethral controlled bladder substitute was constructed from a detubularized, double folded ileal segment in 40 male patients following cystoprostatectomy for bladder cancer. For reflux prevention patients were prospectively randomized to receive either an intussuscepted nipple valve or the ureters were implanted by the Le Duc mucosal trough technique. All patients had normal upper tracts preoperatively. Mean patient age, performance status and stage of cancer were comparable in both groups. Patients were evaluated 6 to 18 months postoperatively. In addition to history taking, assessment included excretory urography, ascending cystography and voiding cystourethrography. During the observation period all patients with nipple valves had normal radiographic appearance of the upper tracts without evidence of reflux. On the other hand, following the Le Duc procedure 12 of 38 renal units (31%) showed evidence of radiographic dilatation. Of the 12 units 11 had stenotic ureters and 1 had reflux. We conclude that nipple valves are more effective in reflux prevention and protection of the upper urinary tract in patients for whom an ileal neobladder is indicated.

Optimization of Replacement of the Ureter by Ileum

Fifty patients for whom an ileal replacement of the ureter was indicated were prospectively randomized among 2 treatment groups according to the surgical technique used. In group 1 the standard operation was performed. In group 2 a tailored and valved (modified) ileal ureter was used. Patients were followed every 3 to 6 months for 12 to 28 months. Kidney functions were evaluated by 99m technetium diethylenetriaminepentaacetic acid scans and by determination of the 24-hour creatinine clearance. Urine cultures were obtained, and urine viscosity and flow rates were measured. A urographic study, including ascending cystography, was done every 6 months. Results indicated that the modified operation is functionally superior to the standard procedure. It provides efficient unidirectional flow of urine from the kidney to the bladder with less mucus secretion. This was ultimately reflected as better renal function when it was quantitated by renography and/or chemical clearance.

Evolution of the Rectal Bladder as a Method for Urinary Diversion

A critical analysis of previous reports reveals 2 main drawbacks of the rectal bladder: 1) recurrent pyelonephritis with subsequent loss of renal function (30 per cent) and 2) nocturnal urinary leakage (40 per cent). In a randomized prospective study the role of a submucosal tunnel for prevention of reflux was evaluated. We demonstrated objectively that this technique could provide a patent unidirectional flow of urine in the majority of cases (82.5 per cent). Urodynamic measurements, including flowmetry, rectal pressure and anal electromyography activities, indicated that the driving force for voiding is the voluntary increase of the intra-abdominal pressure rather than the intrinsic contractions of the smooth muscles of the rectum. Accordingly, attempts at control of nocturnal urinary leakage were directed towards increasing the resistance offered by the pelvic floor. The efficiency of imipramine hydrochloride to achieve this goal was tested against a placebo in a clinical trial performed in a prospective randomized fashion. This treatment was effective in the control of enuresis in a significant number of patients (75 per cent). We conclude that the rectal bladder with a terminal colostomy is a highly recommended method for permanent urinary diversion when these 2 modifications are used.

Urethral Controlled Bladder Substitution: A Comparison Between Parks S Pouch and Hemi-Kock Pouch

To study the effect of the configuration of ileal reservoirs on the urodynamic features, 12 S bladders and 12 Kock pouches were compared. Volume capacity and pressure characteristics were studied 6 months postoperatively. The mean capacity of the reservoirs was 500 +/- 83 ml. for the S bladder and 536 +/- 56 ml. for the Kock pouch. The amplitudes of phasic contractions at 50%, 80% and 100% capacity were similar in both groups. However, the frequency of these contractions was higher in the S bladder. The intraluminal pressure at full capacity was 31 +/- 15 cm. water for the S bladder and 39 +/- 20 cm. water for the Kock pouch. The similar urodynamic features of the S and Kock pouches indicate their ultimate expansion into reservoirs of close physical characteristics and urodynamic behavior.

Serum level of vitamin D in patients with alopecia areata

Abstract Alopecia areata (AA) is an autoimmune disease mediated by both CD4+ and CD8+ T-cells with cytokines playing an important role. Current study aimed at measuring serum 25 hydroxy vitamin D [25(OH) D] level in patients with AA in comparison to controls in our locality.

Is solitary kidney really more resistant to ischemia? An experimental canine study

PURPOSE To our knowledge there are no evidence-based medicine data to date to critically judge the vulnerability of a solitary kidney to warm ischemia compared to paired kidneys. MATERIALS AND METHODS Ten dogs were exposed to open right nephrectomy to create a solitary kidney model (group 1). Ten dogs with both kidneys were considered group 2. All dogs underwent warm ischemia by open occlusion of the left renal artery for 90 minutes. Dogs were sacrificed at different intervals (3 days to 4 weeks). All dogs were reevaluated by renogram before sacrifice and histopathology of the investigated kidney. The proinflammatory markers CD95 and tumor necrosis factor-α were assessed using real-time polymerase chain reaction. RESULTS In group 1 clearance decreased by 20% at 1 week but basal function was regained starting at week 2. In group 2 clearance decreased more than 90% up to week 2. Recovery started at week 3 and by 4 weeks there was a 23% clearance reduction. Histopathological examination in group 1 revealed significant tubular necrosis (60%) at 3 days with regeneration starting at 1 week. In group 2 there was more pronounced tubular necrosis (90%) with regeneration starting at 2 weeks. The expression of proinflammatory markers was up-regulated in each group with higher, more sustained expression in group 2. CONCLUSIONS Solitary kidney in a canine model is more resistant to ischemia than paired kidneys based on radiological, pathological and genetic evidence.

1076 A randomized controlled trial comparing alpha blocker (tamsulosin) and anticholinergic (solifenacin) in treatment of ureteral stent related symptoms

Purpose To compare the effectiveness of tamsulosin and solifenacin in relieving ureteral stents related symptoms.

MP41-02 PROPHYLAXIS AGAINST RENAL ISCHEMIA REPERFUSION INJURY IN CANINE MODEL: STEM CELL APPROACH.

during progression accompanied by modulation of sFlt1. These observations were associated with GEC damage that showed altered VEGFR signaling. Importantly, EVs presented with VEGFRs and angiomodulatory microRNA. These EVs successfully integrated within GEC and modulated VEGF activity. EVs lacking both the full and soluble VEGFR-1 failed to rescue GEC from VEGF inflicted damage. CONCLUSIONS: In conclusion, we demonstrated for the first time the aberration of VEGF signaling within AS glomeruli. We further showed that AFSC derived EVs play important role in maintaining glomerular homeostasis of VEGF signaling, presenting with a potential for new targeted therapies in CKD.