Samer El-Halwagy

Risk factors of hospital readmission after radical cystectomy and urinary diversion: analysis of a large contemporary series

To determine the incidence, risk factors and causes of hospital readmission in a large series of patients who underwent radical cystectomy (RC) and urinary diversion.

Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: A multivariate analysis model for estimating the stone-free probability

To define factors affecting the stone‐free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone‐free probability.

Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: a prospective randomized study of effectiveness and safety in comparison to standard single-pulse technique.

To asses the efficacy and safety of bidirectional synchronous twin‐pulse extracorporeal shock wave lithotripsy (ESWL) compared with standard ESWL.

Short-term results of rotoresection for benign prostatic hyperplasia: a prospective study of safety and efficacy.

To assess the safety and efficacy of rotoresection as a method for treating benign prostatic hyperplasia (BPH).

External stent versus double J drainage in patients with radical cystectomy and orthotopic urinary diversion: A randomized controlled trial.

To compare treatment‐related outcomes of ureteral stenting with an external versus double J stent in patients with orthotopic reservoirs after radical cystectomy.

A 2‐year follow‐up after rotoresection of the prostate: a prospective study

To evaluate the success of rotoresection of the prostate for benign prostatic hyperplasia (BPH), after a follow‐up of 24 months.

Late intestinal obstruction after radical cystectomy and urinary diversion: urological and oncological perspectives

Abstract Objective: The aim of this study was to review different management modalities and outcome of patients presenting with late intestinal obstruction (IO) after radical cystectomy (RC) or palliative cystectomy (PC). Materials and methods: Files of patients who presented with IO between January 1978 and June 2014 were reviewed. Patients who developed IO following either RC or PC more than 30 days after surgery were included. Patients’ characteristics and management protocols were evaluated. Predictors for failure of conservative management and unfavorable outcome after surgical explorations were evaluated. Symptom-free and overall survival rates of patients with malignant IO was were recorded. Results: The prevalence of IO was 2.8% after RC (118 out of 4199 patients) and 10% after PC (nine out of 87). Colonic diversions had the highest prevalence (6.2%), followed by ileal loop conduit (2.9%); the lowest prevalences followed Kock pouch and ileal W neobladder (1.7% and 1.6%, respectively). Postoperative urinary leakage from a ureteroenteric anastomosis was the only predictor for surgical intervention (p = 0.039). Nine cases had been explored for malignant obstruction (eight after RC and one after PC). The mean ± SD elapsed time before death was 3.6 ± 2 months (range 0.5–17 months). Conclusions: Urinary diversion with colonic segments carries more risk for the development of IO in comparison with ileal segments. Postoperative urinary leakage after cystectomy and urinary diversion may be a contributory factor for surgical exploration in cases with late IO.

Coincidental Bladder Cuff Transitional Cell Carcinoma in Nephroureterectomy Specimens: Risk Factors, Prognosis and Clinical Implementation

PURPOSE There is a lack of reporting of the bladder cuff pathology in the literature and ongoing debate regarding the role of bladder cuff excision (BCE) in the prognosis in patients with upper tract urothelial carcinoma (UTUC). We aimed to know the risk factors, the survival, and the clinical course of such pathology. MATERIALS AND METHODS The study was retrospective, from 1983-2013 on 305 patients who had diagnosed with UTUC. Patients were managed by radical open/ laparoscopic nephroureterectomy with bladder cuff excision. The tumor was staged using 1997 TNM classification and the 3-tiered WHO grading system was used for grading. Patients who found to have a malignant bladder cuff on the final pathology were further analyzed for the risk factors for such disease and its effect on survivaltheir outcomes. RESULTS 13/ 281 (4.6%) cases were found to have malignant bladder cuff. Regarding tumor stage; one case was diagnosed with Tis, eight had T1 and four cases had T2 malignant bladder cuff. All cases were with pure ureteric or multifocalcentric tumors, and none had pure pelvicalyceal tumors (p = .001).Local recurrence at the surgical site and distant metastasis were significantly higher among patients with malignant bladder cuff (p = .001 and .002 respectively), and the last sustained its significance in multivariate analysis. Those patients had a poor prognosis when compared to non-malignant bladder cuff cases (Log Rank test, p = .001)Conclusion: Ureteric tumor is the only independent risk factor for malignant bladder cuff at the final pathology and is associated with increased risks for invasive bladder tumor, distant metastasis and poor survival in comparison with non-malignant bladder cuff. In a clinical implementation, BCE is considered as a mandatory step in management of ureteric tumors, while it could be omitted in pure and low grade renal pelvis tumors.

Muscle-invasive bladder and urethral cancer recurrence after surgical management of upper tract urothelial carcinoma: A review of 305 patients

OBJECTIVE Bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC) is a common disease. Although the incidence and risk factors for the development of noninvasive bladder tumor have been reported in many series, rare studies have reported on muscle invasive bladder cancer (MIBC) and its urethral recurrence. We aimed to report the incidence, risk factors and survival rate for the development of MIBC and urethral tumors after surgical management of UTUC. MATERIAL AND METHODS We retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumor was categorized according to the 1997 TNM staging and the 3-tiered WHO grading systems. The primary endpoint of this study was the occurrence of any post-treatment MIBC and its urethral recurrences. We studied the possible risk factors that may contribute to the development of such pathology as well as the prognosis of this pathology. RESULTS A total of 297 patients were eligible for analysis. Intravesical tumor recurrence was observed in 139 (46.8%) patients and radical cystectomy was warranted for 36 patients (MIBC or multicentric bladder recurrence). Twenty-seven patients were fit for surgery with ileal loop conduit was the urinary diversion for the majority, and others received radiotherapy. Ureteral tumor was the only statistically significant risk factor (p=0.001) and the incidence increased as the ureteral tumors became more distal (p=0.01). Occurrence of invasive or multicenteric bladder recurrence was a predictor for local, urethral recurrence and distant metastasis (p=0.016, 0.0001 and 0.01 respectively). Seven patients had urethral urothelial carcinoma; 5 were diagnosed at the time of cystectomy and 2 were discovered later (1 and 3 years after cystectomy). CONCLUSION MIBC is a relatively uncommon (6%) post UTUC, and ureteral tumors, especially distal in location, are the independent risk factor. Extended surveillance for those patients is needed. Urethral cancer recurrence is rare (2%); most cases are localized in the posterior urethra, they are noninvasive, and may develop even after cystectomy.

Risk factors and prognosis of intravesical recurrence after surgical management of upper tract urothelial carcinoma: A 30-year single centre experience

Abstract Objective: To review the incidence, predictors and prognosis of bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC). Patients and methods: We retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumours were categorised according to the 1997 Tumour-Node-Metastasis (TNM) staging and the three-tiered World Health Organization grading systems. The primary endpoint was the occurrence of any intravesical recurrence after treatment. We studied the possible risk factors that may contribute to development of intravesical recurrence, as well as the prognosis of the patients who had recurrence. Results: In all, 297 patients were eligible for analysis. Recurrent bladder tumours occurred in 139 patients (46.8%). The mean (range) time to recurrence after surgery was 33 (6–300) months. Neither sex, past history of bladder tumours, concomitant bladder tumour, the side of the tumour, UTUC stage, grade, presence of carcinoma in situ or multicentricity at the time of diagnosis of UTUC, were significant predictors of intravesical tumour recurrence. Ureteric tumour was the only identified risk factor (P = 0.02). Post-treatment bladder recurrence was a significant predictor of later urethral recurrence (P = 0.002). Conclusions: In our present series, bladder cancer recurrence of urothelial malignancy occurred in nearly half of the patients after surgical management of UTUC. Ureteric tumour was the only identifiable risk factor, thus patients with ureteric tumours may benefit from prophylactic intravesical chemoimmunotherapy. Bladder recurrence does not appear to affect the cancer-specific survival after surgical management of UTUC.