Osama Abdelwahab

Tension-Free Vaginal Tape versus Secure Tension-Free Vaginal Tape in Treatment of Female Stress Urinary Incontinence

Objective: To study the safety and efficacy of both tensionfree vaginal tape (TVT) and secure tension-free vaginal tape (TVT secur) in treatment of female stress urinary incontinence. Patients and Methods: Sixty female patients diagnosed as stress urinary incontinence were evaluated in the urogynecology clinic of the Benha Faculty of Medicine. All patients completed the impact of Incontinence on Quality of Life Questionnaire. They were randomly divided into 2 equal groups: group I (n = 30) underwent TVT procedure and group II (n = 30) underwent TVT secur procedure. The 2 techniques were compared regarding operative time, intraoperative bleeding, duration of catheterization, intra- and post-operative complications and hospital stay. All patients were followed up for 9 months and subjected to evaluation by history, examination, and urodynamics pre- and post-operatively. Results: Operative time and intra-operative morbidity were significantly lower in the TVT secur group than in the TVT group. No significant difference could be detected regarding catheterization period and success rate. The cure rate was 90.1% in group I and 93.4% in group II and this difference was statistically insignificant. Patients with a Valsalva leak point pressure lower than 60 cm H2O had poor outcome in both groups. Conclusion: TVT secur could be considered as a safe, easy and effective alternative to TVT with less morbidity.

Evaluation of the resistive index of prostatic blood flow in benign prostatic hyperplasia

OBJECTIVE The aim of this work is to study the resistive index (RI) of prostatic blood flow by transrectal power Doppler sonography in benign prostatic hyperplasia (BPH) to determine its correlation with other parameters of BPH. MATERIALS AND METHODS Eighty-two male patients aged 52-86 years with lower urinary tract symptoms (LUTS) due to BPH were included in the study. Patients with prostate cancer, neurogenic bladder, or with other pathology (e.g. prostatitis, bladder stone) were excluded from the study. All patients were evaluated by full history including Internatinoal Prostate Symptoms Score (IPSS), general and local examination (DRE), neurologic examination, uroflowmetry, laboratory investigations including urine analysis, routine laboratory tests and serum prostate specific antigen (PSA). Transrectal ultrasonography was used to calculate the total prostatic volume. Transrectal Power Doppler Ultrasound (PUD) was used to identify the capsular and urethral arteries of the prostate and to measures the RI value. RESULTS The mean prostate volume was 75.1 ± 44.7 g. The mean RI of the right and left capsular arteries were 0.76 ± 0.06 and 0.76 ± 0.07, respectively. The mean RI of the urethral arteries was 0.76 ± 0.08. There was a high significative correlation between the increase of the RI of the right and left capsular and urethral arteries and the degree of obstruction (P value < 0.001), severity of symptoms (P value < 0.001) and also the prostatic volume (P value < 0.001). CONCLUSION Resistive index of the prostatic blood flow can be applied as an easy and non-invasive tool to evaluate the lower urinary tract obstruction due to BPH.

Defining a Hba1c Value That Predicts Increased Risk Of Penile Implant Infection

To re‐evaluate the role of diabetes mellitus (DM) as a risk factor for penile implant infection by exploring the association between glycated haemoglobin (HbA1c) levels and penile implant infection rates and to define a threshold value that predicts implant infection.

Erect Penile Dimensions in a Cohort of 778 Middle Eastern Men: Establishment of a Nomogram

INTRODUCTION Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on the subject, particularly in different ethnic groups and for erect penis size. AIM The aim of this study was to create a nomogram of erect penile dimensions in a large sample of Middle Eastern men. METHODS A retrospective cohort study of 778 men (mean age 43.7; range 20-82) attending urological outpatient clinics in Saudi Arabia was conducted. Exclusion criteria were age under 18 years, a presenting complaint of small or short penis, Peyronies disease or complaint of congenital curvature, clinical hypogonadism, and previous penile surgery or trauma. MAIN OUTCOME MEASURES Three erect penile dimensions following induction of erection using intracavernosal injection of Quadrimix. RESULTS Mean patient body mass index (BMI) was 29.09 (standard deviation [SD] 5.76). The mean suprapubic skin-to-penile tip erect length was 12.53 cm (SD 1.93); the mean erect length from the symphysis pubis to the penile tip was 14.34 cm (SD 1.86); and the mean erect shaft circumference was 11.50 cm (SD 1.74). A nomogram was constructed and statistical analysis performed, demonstrating a weak negative correlation between BMI and erect penile length measured from the suprapubic skin (r = -0.283, P < 0.000) but not from bone to tip, and a weak negative correlation between age and both erect penile length measurements (skin to tip r = -0.177, P < 0.0005; bone to tip r = -0.099, P = 0.006). CONCLUSION A nomogram for Middle Eastern men can be used as a standard when advising men with small penis anxiety. The importance of measuring erect size and allowing for infra-pubic fat interference in measurement is emphasized. We envisage that this tool can be used to educate and reassure concerned men about the size of their penises.

Posterior tibial nerve stimulation as treatment for the overactive bladder.

Abstract Objective: To evaluate the efficacy of posterior tibial nerve stimulation (PTNS) as a treatment for the overactive bladder (OAB) resistant to medical treatment. Patients and methods: The study included 60 patients, comprising 55 women (92%) and five men (8%) with a mean (SD) age of 41.4 (10.8) years, who presented to the Urology Department of Benha University Hospital from June 2010 to October 2012. All patients were assessed initially by taking a history, a physical examination, urine analysis, routine laboratory investigations, and a urodynamic evaluation in the form of flowmetry, cystometry, and a pressure-flow study in some cases. A voiding diary (daytime and night-time frequency, voiding volume, and leakage episodes) was completed by all patients, and all underwent 12 sessions of PTNS using a personal computer-based system, and were reassessed after the sixth session, at the end of the course, and at 3 and 6 months after the last session, using the same methods as in the baseline visit. Results: There was a statistically significant improvement in all the variables assessed. No infection or failure of the PTNS mechanism was detected while using the technique, but there were rare instances of minor bleeding and a temporary painful feeling at the insertion site. Conclusion: PTNS is safe, and gives statistically significant improvements in the patient’s assessment of OAB symptoms.

Noninvasive treatments for iatrogenic priapism: Do they really work? A prospective multicenter study.

Objectives: Intracorporeal injections (ICIs) of vasoactive substances during penile Doppler ultrasound (PDU) are a common investigation for erectile dysfunction (ED) diagnosis. ICI can be responsible of priapism, a pathological condition of prolonged penile erection not related to sexual stimulation. The aim of our study is to investigate the effectiveness of physical exercise and medical treatment as noninvasive therapy to restore detumescence in prolonged erections after ICI. Materials and Methods: Data were prospectively collected on men undergoing PDU in three urological centers. Three hundred and sixty-nine patients underwent PDU for the investigation of ED. All the participants received an ICI of quadrimix; prostaglandine E1, papaverine, phentolamine, and atropine. The data of the patients have been analyzed to record their comorbidities, results of PDU, and the complications encountered. Results: Fifty-three patients (14.4%) developed prolonged erections. Physical exercise alone was successful in reversing prolonged erection within 30 min in 21 (39.6%) patients. Out of the remaining 32 patients, oral salbutamol induced detumescence in 18 (34%) within the observation period of 60 min. Nonresponders were managed successfully with aspiration and irrigation of corpora with saline (11 patients, 20.75%) or with Phenylephrine (three patients, 5.66%). Conclusions: Physical exercise and oral salbutamol are safe and effective in restoring detumescence of pharmacologically-induced priapism. Noninvasive therapy may save a significant number of these patients an invasive treatment.

Efficacy of botulinum toxin type A 100 units versus 200 units for treatment of refractory idiopathic overactive bladder

ABSTRACT Objective: To evaluate the efficacy and safety of a single intra detrusor injection of BoNTA comparing two different doses (100 U or 200 U) in patients with idiopathic overactive bladder. Materials and Methods: A randomized prospective study evaluated the efficacy of BoNTA in management of refractory idiopathic overactive bladder and included 80 patients. All patients were assessed initially by taking a history, a physical examination, overactive bladder symptom score, urine analysis, routine laboratory investigations, KUB and pelviabdominal. OABSS was adjusted on all patients postoperative at 1,3,6,9 months also Urodynamic was done for all patients preoperative and postoperative at 3, 6, 9 months. Results: The mean age was 30.22±8.37 and 31.35±7.61 in group I and II respectively. There was no statistically difference between both groups in all parameters all over the study except at 9 months after treatment. Hematuria was observed 6 and 9 patients in group I and II respectively. Dysuria was observed in 6 and 15 patients in group I and II respectively. UTI was detected in 3 and 7 patients in group I and II respectively. Conclusion: A single-injection procedure of 100 U or 200 U BoNTA is an effective and safe treatment for patients with IOAB who failed anticholinergic regimens. OABSS and QoL were improved for 6 months; 100 U injections seemed to have comparable results with 200 U. There was a significant difference at month 9 towards 200 U with more incidences of adverse events.

Chimney Modification Technique for Ureterointestinal Anastomosis after Radical Cystectomy: Preliminary Evaluation of Short-term outcome and Impact on Quality of Life

Objectives: To evaluate the short-term outcome of chimney modification technique of the Hautmann ileal neobladder for ureterointestinal anastomosis after radical cystectomy in cases of invasive bladder cancer. Patients and Methods: The study included 25 male patients with a mean age of 61.2 ± 6.6 years assigned for radical cystectomy. A neobladder reservoir was fashioned using an ileal loop in a W-shape with both ends not detubularized and used as chimneys of 3–5 cm for the afferent limb on each side for implantation of the 2 cm spatulated ureter into each side using the technique of end-to-end anastomosis. Patients were observed for early postoperative complications and ascending cystography was performed before catheter removal for assessment of reflux and pouch integrity. Postoperative follow-up assessment included evaluation of continence satisfaction, renal function was judged by estimation of serum creatinine and intravenous urography for evaluation of development of ureteric stricture. Quality of life (QoL) was assessed using the Quality of Life Questionnaire (QLQ-C30). Results: All patients passed a smooth intra-operative course with a mean operative time of 308 ± 53.2 minutes and mean intra-operative blood loss of 580 ± 175 ml. No mortality was reported, however, 3 patients had postoperative wound infection, another 3 patients had prolonged ileus for >48 hours and one patient developed neobladder leakage that was managed by prolonged uretheral catheterization for 5 weeks. Fourteen patients reported good continence for both day and night, 9 patients had good to satisfactory continence, while two patients had unsatisfactory continence. Postoperative serum creatinine levels were non-significantly higher compared to preoperative measurements. Urographic studies demonstrated no reflux or stricture in either of the implanted ureters, or hydronephrosis after 12-month followup. Throughout the first 6 months of follow-up, all patients showed progressive increase of total QoL score with a significant difference compared to that recorded at the first month post-operation and the mean 12-month collective score was improved by a mean score of 14.4 ± 5.4 than that of the first month post-operation. Conclusion: Chimney modification of the Hautmann neo-bladder after radical cystectomy is simple, safe and free of ureteric stricture or reflux. Also, the applied technique improved patient’s postoperative QoL.

Outcomes of variation in technique and variation in accuracy of measurement in penile length measurement

Accurate data regarding the size of the erect penis is of great importance to several disciplines working with male patients, but little data exists on the best technique to measure penile length. While some previous small studies have suggested good correlation between stretched penile length, others have shown significant variability. Penile girth has been less well studied, and little data exist on the possible errors induced by differing observers and different techniques. Much of the published data report penile length measured from the penopubic skin junction-to-glans tip (STT) rather than pubic bone-to-tip (BTT). We wished to assess the accuracy of different techniques of penile measurements with multiple observers. Men who achieved full erection using dynamic penile Doppler ultrasound for the diagnosis of sexual dysfunction or a desire for objective penile measurement were included in the study. Exclusion criteria were penile scarring, curvature, or congenital abnormality. In each case, the penis was measured by one of the seven andrology specialists in a private air-conditioned (21 °C) environment. Each patient had three parameters measured: circumference (girth) of the penile shaft, length from suprapubic skin-to-distal glans (STT), and pubis-to-distal glans (BTT). The three measurements were recorded in the stretched flaccid state, and the same three measurements were then repeated in the fully erect state, following induction of full erection with intracavernosal injection. We analyzed the accuracy of each flaccid measurement using the erect measurements as a reference, for the overall patient population and for each observer. In total, 201 adult men (mean age 49.4 years) were included in this study. Assessing the penis in the stretched and flaccid state gave a mean underestimate of the erect measurement of ~20% (STT length 23.39%, BTT length 19.86%, and circumference 21.38%). In this large, multicenter, multi-observer study of penis size, flaccid measurements were only moderately accurate in predicting erect size. They were also significantly observer dependent. Measuring penile length from pubic bone to tip of glans is more accurate and reliable, the discrepancy being most notable in overweight patients.

A comparative study between full-dose and half-dose intravesical immune bacille Calmette-Guérin injection in the management of superficial bladder cancer.

Abstract Objectives: To determine whether a half-dose of bacille Calmette–Guérin (BCG) can reduce toxicity without affecting its efficacy in the management of non-muscle-invasive bladder cancer. Patients and methods: From January 2012 to January 2014, 80 patients with superficial bladder cancer and in the intermediate-risk group were simply randomised to receive two different doses of BCG, i.e., a full dose of 90 mg (group A) or a half-dose of 45 mg (group B). There were no significant differences in clinical and pathological characteristics between the groups. At completion of the study, 40 patients could be evaluated in each group. Results: All patients were evaluated for a follow-up of 12 months after treatment. There was no significant difference in recurrence rate (15 patients, 38%, in group A and 16, 40%, in group B) in the two groups, and no difference in progression rate of the disease, at eight patients (20%) in each group. There were significant differences between groups A and B in toxicity (grade 1 adverse events, 70% vs. 60%; grade 2, 18% vs. 7.5%, respectively). Grade 3 adverse events were only reported in group A (2.5%). Conclusion: The half dose of intravesical BCG instillation can reduce the toxicity and side-effects that are associated with the treatment of superficial bladder cancer, without affecting the efficacy of therapy.