Mohamed H. Zahran

Health-related quality of life after radical cystectomy and neobladder reconstruction in women: impact of voiding and continence status.

To assess health‐related quality of life, and the impact of night‐time incontinence and chronic urinary retention on health‐related quality of life in women with bladder cancer after radical cystectomy and orthotopic neobladder.

Salvage of grafts with vascular thrombosis during live donor renal allotransplantation: a critical analysis of successful outcome.

To report a high‐volume institution experience with salvage techniques for vascular accidents during live donor renal allotransplantation.

Acute kidney injury after percutaneous nephrolithotomy for stones in solitary kidneys

Abstract Objectives: The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys. Methods: The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2–5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI. Results: The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively). Conclusions: The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.

Inflammatory pseudotumor of the urinary bladder: A case series among more than 2,000 urinary bladder tumor cases

“Inflammatory pseudotumor” (IPT) has infrequently been reported in the medical journals. A retrospective analysis was conducted among more than 2,000 bladder tumor cases from January 1999 to December 2012 looking for patients with IPT in the final diagnosis. Six patients were found with median tumor size of 3.5 cm (range: 3–8 cm); computed tomography and/or magnetic resonance imaging was used to diagnose the tumor. All patients had complete resection of the tumors. On a median follow-up of 6 years (range: 2–10 years), no recurrences for IPT have been observed in all patients. We concluded that IPT is a rare disease of the urinary bladder and should be regarded with a high degree of suspicion. Although an extensive workup may be needed for definite diagnosis, it is worth to avoid unnecessary chemoradiotherapy or radical surgeries.

Female sexual dysfunction post radical cystectomy and urinary diversion

Abstract Objectives: To evaluate the impact of radical cystectomy and urinary diversion on female sexual function. Materials and methods: A Medline search was conducted according to the PRISMA statement for all English full-text articles published between 1980 and 2016 and assessing female sexual function post radical cystectomy and urinary diversion. Eligible studies were subjected to critical analysis and revision. The primary outcomes were the reporting methods for female sexual dysfunction (FSD), manifestations of FSD, and factors associated with FSD, postoperative recoverability of FSD, and awareness level regarding FSD. Results: From the resulting 117 articles, 11 studies were finally included in our systematic review, with a total of 361 women. Loss of sexual desire and orgasm disorders were the most frequently reported (49% and 39%). Dyspareunia and vaginal lubrication disorders were reported in 25% and 9.5%, respectively. The incidence of sexual dysfunction was 10% in 30 patients receiving genital- or nerve-sparing cystectomy vs. 59% receiving conventional cystectomy. Conclusion: Although female sexual function is an important predictor of health-related quality of life post radical cystectomy and urinary diversion, the available literature is not enough to provide proper information for surgeons and patients.

Prepubertal testicular tumours: Should testicular-sparing surgery be considered? A single-institution experience and review of the literature.

Abstract Objectives: To review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery. Patients and methods: We retrospectively reviewed all cases of testicular tumours managed at our institution between 1999 and 2009. Boys aged <16 years were included in the study. The patients’ characteristics, presentation, the diagnostic tools, tumour markers, mode of treatment, pathological findings and outcome were assessed. We reviewed previous reports that addressed testicular and paratesticular tumours in prepubertal boys, using a Medline/PubMed search. Results: From 80 patients, 13 boys (median age 8.7 years) presented with testicular tumours (16%) and were included in the study. Two boys presented with precocious puberty and one with gynaecomastia. The level of α-fetoprotein was high in three boys, and the human chorionic gonadotrophin level was elevated in one, and both markers were high in one. Testicular-sparing surgery was performed in three boys. Six of the 13 tumours were malignant and seven were benign. None of the patients developed a recurrence or testicular atrophy after testicular-sparing surgery. From the review of previous reports we devised an evidence-based algorithm for managing prepubertal testicular tumours. Conclusions: Paediatric testicular tumours are rare but they require an inguinal approach for either orchidectomy or testicular-sparing surgery; we recommend the latter option as long as frozen sections are analysed and a safety margin is maintained.

Simultaneous peritoneal and retroperitoneal splenosis mimics metastatic right adrenal mass

Highlights • Incidentally discovered adrenal mass (adrenal incidentalomas “AIs”) has a widespread diversity of differential diagnosis.• Adrenal masses >6 cm in diameter and malignancy should be considered malignant.• Large right AI could be a splenosis following post-traumatic splenectomy.

Chronic urinary retention after radical cystectomy and orthotopic neobladder in women: Risk factors and relation to time

PURPOSE To investigate the long-term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors. MATERIAL AND METHODS We retrospectively analyzed a prospectively evaluated cohort of women for whom RC and ONB were performed. Patients in CUR were evaluated for the cumulative incidence of CUR using Kaplan-Meier curve and for the possible risk factors using log rank and Cox regression analysis. RESULTS A total of 234 women with mean age ± SD of 52.3 ± 9 years and a median (range) of follow-up of 92 (12-247) months were included. The incidence of CUR increased with time, where 12 (5.2%), 21 (8.97%), 35 (14.9%), 53 (22.6%), and 56 (24%) patients started clean intermittent catheterization in 1, 2, 2 to 5 years, 5 to 10 years, and after 10 years of follow-up, respectively. In univariate and multivariate analysis, diabetes mellitus and urethral Kock pouch were independent predictors of CUR development (HR [95% CI] = 2.45 [1.2-5.1], and 2.1 [1.05-4.2], P = 0.01 and 0.03, respectively). Genital- sparing RC and surgical modification to provide pouch back support were independent factors that reduce CUR development (HR [95% CI] = 9.3 [1.25-69.9], and 2.1 [1.19-3.9], P = 0.02 and 0.01, respectively). CONCLUSION The incidence of CUR after RC and ONB in women increases with time even after 10 years of follow-up. Presence of diabetes mellitus increases the risk of CUR development. Genital-sparing RC and modification to prevent CUR reduced the likelihood of CUR development.

MP06-09 LOCAL SILDENAFIL ACCELERATE RENAL REGENERATION AFTER ISCHEMIA/ REPERFUSION INJURY IN CANINE MODEL.

INTRODUCTION AND OBJECTIVES: As the waiting time increases for listed renal failure patients, it is becoming common to encounter patients with minimal or no urine output with small shrunken bladders at the time of transplant. Mirabegron has proven benefit in treating overactive bladder(OAB) symptoms by relaxing the bladder through beta-3-adrenergic receptors. Our aim is to evaluate the efficacy of Mirabegron following kidney transplantation on patients with small bladder capacity. METHODS: Kidney transplant recipients with small bladder volumes who experienced OAB symptoms and were started on Mirabegron therapy within 3 months after transplant were included in this study. Patients were excluded if they had evidence of urinary tract infection or a history of complex urologic surgeries preceding transplantation. We used the OAB-symptom score (OAB-SS; Journal of Urology, 2007), a simple self-report questionnaire evaluating OAB symptoms. The minimum OAB-SS score for inclusion was 12. Patient demographics and OAB-SS pre and post-Mirabegron were collected and compared using paired t-test analysis. RESULTS: The 36 participants were predominantly male (83%) anddeceased-donor kidney transplant recipients (86%).Medianagewas 48 years (IQR 36.5-60). 47% of patients reported pre-transplant urinary symptoms, most commonly recurrent UTI (28%). BPH-lower urinary tract symptoms (LUTS) reported by 30% of males may contribute to the sample sex imbalance. Before Mirabegron initiation, 44% of patients had failed trials of at least one pharmacologic agent and over 20% had failed trials of at least two medications. After starting Mirabegron therapy, 86% reported a decrease in OAB-SS. Overall mean score change was -4.7 points (p<0.001). Mean score on each OAB-SS survey question also decreased significantly (p<0.001, Table 2). CONCLUSIONS: Mirabegron effectively reduces severity of symptoms related to small bladder volume following renal transplantation by increasing bladder relaxation and storage capacity.

MP07-20 THE IMAPCT OF TESTICULAR CANCER ON MALE FERTILITY; ABNORMALITIES DETECTED AND AETIOPATHOGENESIS

CONCLUSIONS: Our results point out, that smoking could possibly lead to a reduction of sugar binding proteins on the human sperm glycocalyx. This could be a reason for a decreased binding capacity of sperms to the female reproductive tract which could lead to a reduced fertility potential of smokers. Further work is necessary to lighten the exact molecular interaction between spermatozoa and female reproductive tract. Based on these facts it might be possible to examine new diagnostic and therapeutic approach in the future.