Tarek Mohsen

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.

Treatment of symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy

To report our experience with the use of 95% ethanol as sclerotherapy for symptomatic simple renal cysts.

Penile fracture: long-term outcome of immediate surgical intervention.

OBJECTIVES To assess the etiology and the late effects of penile fractures treated by immediate surgical intervention. METHODS Between 1986 and 2008, a total of 155 patients with penile fracture were treated surgically in our center. The interval from injury to presentation was between 1 and 96 hours. Those patients were contacted by mail or phone and were re-evaluated. All patients were re-evaluated by questionnaire and local examination. Patients with erectile dysfunction were evaluated by color Doppler ultrasonography. RESULTS The most common cause of fracture of penis is sexual intercourse (51.5%). Unilateral and bilateral corporeal ruptures were present in 139 (89.7%) and 3 (1.9%) cases, respectively, whereas no tunical tear was found in 13 (8.4%) cases. Concomitant urethral injury was present in 14 (9%) cases. Long-term follow-up (>12 months) was available for 141 patients; among whom there was no complications in 108 (77%), painful erection in 2 (1.3%), penile deviation in 5 (3.2%), both in 1 (0.7%), erectile dysfunction in 11 (7.8%), and palpable scarring in 14 (10%). Scar formation was highly associated using nonabsorbable sutures (P <.001). CONCLUSIONS Vigorous sexual intercourse was found to be the most common cause of penile fracture. Immediate surgical intervention has low morbidity, short hospital stay, rapid functional recovery, and no serious long-term sequelae. Nonabsorbable sutures should be avoided as it has a higher incidence of scar formation.

The Use of Halofuginone in Limiting Urethral Stricture Formation and Recurrence: An Experimental Study in Rabbits

PURPOSE We developed a reproducible animal model for the induction of urethral stricture in the rabbit and evaluated the role of halofuginone in limiting stricture formation. MATERIALS AND METHODS A total of 20 New Zealand male rabbits were used in the first phase of the experiment. Bulbar urethral stricture was induced by electrocoagulation. The animals were then randomly assigned to 2 groups of 10 each, which received a diet containing halofuginone or a normal diet. In the second phase electrocoagulation induced stricture was treated with visual internal urethrotomy in 45 rabbits. These rabbits were randomly assigned to 2 groups, namely a halofuginone and a control group. RESULTS In the first phase stricture developed in 2 study rabbits (20%) vs 10 controls (100%). In the second phase 37 rabbits were evaluable (8 died). Recurrent stricture was observed in 5 of the 18 study rabbits (27%) vs 14 of the 19 controls (73%). CONCLUSIONS Halofuginone is effective in limiting the occurrence of de novo urethral stricture and recurrent stricture after visual internal urethrotomy. This antifibrotic molecule may become an important therapy to treat urethral stricture and/or recurrence following endoscopic manipulation of stricture in humans.

Long-term follow-up of living kidney donors: a longitudinal study

To analyse retrospectively the general health status and renal and cardiovascular consequences of living‐related kidney donation, as the long‐term effects of unilateral nephrectomy for kidney donation are of particular interest with the currently increasing practice of living‐donor transplantation.

Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury

To assess the long‐term morphological and functional outcome of superselective transarterial embolization (TAE) for treating traumatic renal vascular injury.

Functional and morphological effects of postpercutaneous nephrolithotomy superselective renal angiographic embolization.

OBJECTIVES To evaluate the functional and morphological effects of postpercutaneous nephrolithotomy (PCNL) superselective renal angiographic embolization. METHODS Between January 1995 and March 2006, superselective renal angiography was needed to control severe bleeding after 41 of 4095 PCNL procedures (1%). We evaluated the short-term effects of embolization after 3 months with renal ultrasonography (RUS), dimercaptosuccinic acid (DMSA) renal scan, and estimation of serum creatinine. We evaluated long-term morphological and functional effects with RUS, DMSA renal scan, and excretory urography (IVU). RESULTS Bleeding was controllable with superselective embolization in 38 patients (93%). Six of them developed early postembolization complications, in the form of perinephric hematoma in 4 and urinary leakage in 2 patients. At 3 months, serum creatinine levels increased in 3 of 9 patients with a solitary kidney, but none required renal replacement therapy. Long-term follow-up was completed for 30 patients for a mean period of 3.9 +/- 2.3 years. We performed IVU for 27 patients. Among them, 2 renal units (7%) showed no dye excretion. DMSA scans showed homogeneous distribution of radiotracer with no evidence of photopenic areas in 6 renal units (20%). The mean percentage of DMSA uptake by the corresponding kidney improved from 25 +/- 9% at the 3-month scans to 34 +/- 11% at the last follow-up scans (P <0.001). CONCLUSIONS The short-term deleterious effects of superselective renal embolization for post-PCNL renal vascular injuries were more pronounced in patients with a solitary kidney. However, the long-term follow-up showed functional and morphological improvements.

Long-term Functional Outcome of Percutaneous Nephrolithotomy in Solitary Kidney

OBJECTIVE To evaluate the long-term functional outcome of percutaneous nephrolithotomy (PNL) for calculi in solitary kidneys and to determine factors leading to renal function deterioration. MATERIALS AND METHODS The computerized files of patients with solitary kidneys who underwent PNL between January 2002 and December 2009 were retrospectively reviewed. Patients with follow-up <2 years were excluded. Complications, secondary procedures, and stone-free rates were recorded. Changes in the renal function were judged by comparing preoperative and postoperative estimated glomerular filtration rates. Preoperative, intraoperative, and postoperative factors that may affect renal function were tested using univariate and multivariate analyses to define risk factors for deterioration of renal function on long-term follow-up. RESULTS The study included 200 patients (133 men [66.5%] and 67 women [33.5%] with mean age 52.3 ± 11.7 years). Complications were reported in 34 patients (17%). Severe bleeding was noticed in 10 patients (5%). The overall stone-free rate was 89.5%. After a mean follow-up of 3 ± 1.4 years (range, 2-8), there was significant improvement of the estimated glomerular filtration rate from 57 to 64 mL/min (P <.001). Thirty-one patients (15.5%) showed deterioration of the renal function. Multiple punctures and postoperative bleeding were independent risk factors for renal function deterioration (odds ratio was 3.7 and 4.5, respectively). CONCLUSION PNL for calculi in solitary kidneys provided significant improvement in renal function at long-term follow-up. Multiple punctures and severe bleeding are independent risk factors for deterioration of the kidney function.

Does timing of presentation of penile fracture affect outcome of surgical intervention

OBJECTIVE To assess the effect of timing of presentation of cases with penile fracture on the outcome of surgical intervention. PATIENTS AND METHODS Between January 1986 and May 2010, 180 patients with penile fracture were treated surgically in our center. To assess the effect of timing of presentation, patients were classified into 2 groups: group I with early presentation (≤24 hours) and group II with delayed presentation (>24 hours). All patients were contacted by mail or phone and were re-evaluated. All patients were reevaluated by questionnaire and local examination. Patients with erectile dysfunction were evaluated by color Doppler ultrasonography. RESULTS Group I included 149 patients (82.8%) and group II included 31 (17.2%). In group I, patients presented to the emergency department from 1-24 hours (mean, 11.8) after occurrence of the penile trauma. Although patients in group II presented from 30 hours to 7 days (mean, 44.7 hours). Both groups were similar regarding etiology of injury, clinical presentation, surgical findings, and incidence of associated urethral injury. Mean follow-up period for group I was 105 months, and for group II it was 113 months. After such long-term follow up, 35 (19.4%) patients had complications; however, there was no statistically significant difference between both groups. CONCLUSIONS Cases of penile fracture with early or delayed presentation up to 7 days should be managed surgically. Both groups have comparable excellent outcome with no serious long-term complications.

Internal iliac artery embolization for the control of severe bladder hemorrhage secondary to carcinoma: long-term follow-up.

The purpose of this study was to evaluate the efficacy and long-term complications of internal iliac artery embolization as a palliative measure in the control of intractable hemorrhage from advanced bladder malignancy. From January 1998 through December 2005, seven patients underwent transcatheter arterial embolization (TAE) of anterior division of internal iliac artery bilaterally for intractable bladder hemorrhage. After embolization, patients were followed for the efficacy of the procedure in controlling hematuria and complications. TAE was successful in immediate control of severe hemorrhage in all seven patients after a mean period of 4 days. At a mean (range) follow-up of 10 (6–12) months, the hemorrhage was permanently controlled in four (57%) patients. Three patients developed hematuria and required emergency admissions; two had mild hematuria and were managed conservatively, and the remaining one required a second attempt of embolization after 2 months from the first one. During the whole period of follow-up, there were no significant complications related to embolization. Internal iliac artery embolization is an effective and minimally invasive option when managing advanced bladder malignancies presenting with intractable bleeding. The long-term follow-up showed control of bleeding in the majority of such patients with no serious complications.