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Mahfouz W, Eid AA, Elbadry M, Elkhiat A, Moussa A, Assem A. Transobturator Tension-Free Vaginal Flap Operation versus Synthetic Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A Prospective Randomized Study. Urol Int 2023; 107:785-791. [PMID: 37499640 DOI: 10.1159/000529808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. METHODS This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. RESULTS Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. CONCLUSIONS TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed.
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Affiliation(s)
- Wally Mahfouz
- Urology department, Alexandria University, Alexandria, Egypt
| | | | | | | | - Ahmed Moussa
- Urology department, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Urology department, Alexandria University, Alexandria, Egypt
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Morsy S, Elkholy A, Sadek S, Assem A. Efficacy and safety of low-dose tadalafil compared to tolterodine and placebo in females with overactive bladder symptoms. A prospective double blind controlled study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Badawy H, Dawood W, Soliman A, Fahmy A, Mahfouz W, Moussa A, Assem A, Eid A, Elsayed S, Gawan A, Hanno A, Youssef M. Reply to letter to the editor: Staged repair of proximal hypospadias-reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg 2021; 56:2124. [PMID: 34229877 DOI: 10.1016/j.jpedsurg.2021.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Waleed Dawood
- Department of Urology, University of Alexandria, Egypt
| | | | - Ahmed Fahmy
- Department of Urology, University of Alexandria, Egypt
| | - Waly Mahfouz
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, University of Alexandria, Egypt
| | - Akram Assem
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Eid
- Department of Urology, University of Alexandria, Egypt
| | - Shaymaa Elsayed
- Department of Pediatrics, Section of Endocrinology, University of Alexandria, Egypt
| | - Ahmed Gawan
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Egypt
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Assem A, Hamdy SM, Beltagy AM, Serdar Gӧzen A, Abou Youssif T. Prospective evaluation of urinary continence after laparoscopic radical prostatectomy using a validated questionnaire and daily pad use assessment: which definition is more relevant to the patient's perception of recovery? Cent European J Urol 2021; 74:196-200. [PMID: 34336238 PMCID: PMC8318029 DOI: 10.5173/ceju.2021.0004.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction No standard definition for urinary continence after radical prostatectomy exists, and there are discrepancies in continence rates reported in the literature, as well as rates reported by physicians and patients. Therefore, we used two tools, a validated questionnaire and daily pad use, to identify the criteria that best reflects patients’ perceptions of continence recovery. Material and methods This is a prospective study of 74 patients who underwent nerve-sparing laparoscopic radical prostatectomy. Continence was assessed monthly for 3 months following catheter removal using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) and by recording the number of pads the patients used on a daily basis. According to daily pad use, patients were categorized as either dry (no-pads), socially continent (0–1 pad) or incontinent (≥2 pads). Results Seventy-four patients were enrolled with a mean age of 64.3 (±5.6) years. There were no significant differences in continence rates using scores from the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-UI SF) or no-pad use (29.7% vs 32.4%, 45.9% vs 48.6% and 54.1% vs. 54.1%, at the 1-, 2- and 3-month follow-ups, respectively). However, the number of socially continent patients was significantly higher (59.5%, 70.3% and 81.1%, at the 1-, 2- and 3-month follow-ups, respectively [p <0.001]). Conclusions The totally dry definition better reflected patients’ perceptions rather than the socially continent definition for the evaluation of continence recovery following laparoscopic radical prostatectomy. To avoid discrepancies, we recommend the use of a validated questionnaire as well as the no-pad definition to standardize the reporting of post radical prostatectomy continence rates.
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Affiliation(s)
- Akram Assem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Seif M Hamdy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad M Beltagy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ali Serdar Gӧzen
- SLK-Kliniken Urology Department, Heidelberg University, Heilbronn, Germany
| | - Tamer Abou Youssif
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Elghazaly H, Mottet N, Garcia J, Oudard S, Roach M, Abbou C, Merseburger A, Emara A, Shehata S, Tawfik H, Khorshid O, Selim A, Assem A, Abdelkarim K, Ezz El-Arab L, Bazarbashi S, Omar A, Elwakil H, Elashry M, Abou ElFotouh M, Osman T, Ezz El Din M. Clinical recommendations in the management of advanced prostate cancer: International Gastrointestinal, Liver and Uro-oncology (IGILUC 2019) experts. World J Urol 2021; 39:1421-1429. [PMID: 32643031 DOI: 10.1007/s00345-020-03328-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/23/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Advancements in the diagnosis and treatment of prostate cancer (PC) have rapidly progressed through the past years. Various factors should be taken into account while treating individual patients to ensure optimal and careful decision making. The purpose of this consensus review is to summarize the current practice patterns when managing patients with advanced prostate cancer (APC) as there is still a lack of or very limited evidence on its clinical management in some areas. METHODS Pre-defined questions were shared with experts prior to the consensus session that took place in Cairo, Egypt in April 2019 during the 8th International gastrointestinal, liver and uro-oncology conference (IGILUC). Voting was based mainly on the expert opinions of the panel after a thorough discussion and review of available evidence from guidelines or best evidence available concerning the topic at hand. RESULTS A strong consensus or unanimity was reached on 47% of the proposed questions. Notably, the panelists reached consensus on several topics based on high-level expert opinion. These findings contribute in several ways to our understanding of the management of PC and provide a basis for future recommendations. There was also a lack of consensus on other several topics, which suggests the need for further supporting data addressing these knowledge gaps. CONCLUSION This review offers a thorough understanding of APC practice and offers insight on the various opinions shared amongst experts in the field that can serve as guidance regionally and deepens our understanding of disease management globally.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Jorge Garcia
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephane Oudard
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France
| | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Claude Abbou
- Department of Urology, Hôpital Henri Mondor, Creteil, France
| | - Axel Merseburger
- Department of Urology and Urologic Oncology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Amr Emara
- Department of Urology, Hampshire Hospitals, NHS Foundation Trust, Basingstoke, UK
| | - Samir Shehata
- Clinical Oncology Department, Assiut University Cancer Centre, Assiut, Egypt
| | - Hesham Tawfik
- Clinical Oncology Department, Tanta University, Tanta, Egypt
| | - Ola Khorshid
- Medical Oncology Department National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Selim
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akram Assem
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Khalid Abdelkarim
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Lobna Ezz El-Arab
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shouki Bazarbashi
- Medical Oncology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abbass Omar
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hesham Elwakil
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Elashry
- Department of Clinical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abou ElFotouh
- Department of Clinical Oncology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Tarek Osman
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Mai Ezz El Din
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Fahmy A, Abdeldaiem H, Abdelsattar M, Aboyoussif T, Assem A, Zahran A, Elgebaly O. Impact of Bariatric Surgery on Sexual Dysfunction in Obese Men. Sex Med 2021; 9:100322. [PMID: 33592350 PMCID: PMC8072175 DOI: 10.1016/j.esxm.2021.100322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Currently bariatric surgery is the most effective treatment for significant and sustained weight loss. Erectile and endothelial dysfunctions may share some metabolic and vascular pathways in common that may be influenced by weight loss. Aim The aim of the study was to assess the impact of surgically induced weight loss on the erectile function on obese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to examine the proposed underlying mechanism associated with improvement in erectile function after weight loss by LSG. Methods Eighty-two consecutive obese men who underwent a LGS were followed up for 12 months. All operations were performed by the same surgeon at a single institution. Main Outcome measure Patients were examined both before and after 12 months of LSG for biochemical tests; total serum cholesterol, triglyceride, C-reactive protein, interleukin-6, and endothelial nitric oxide synthase, and for erectile function tests. International Index of Erectile Function (IIEF) scores were recorded. Results Eighty-two men (mean age 39 ± 14.6 years, range 24–62; mean BMI 41.2 ± 4.8 kg/m2) completed all preoperative and postoperative questionnaires and biochemical tests. At 12 months, the mean weight loss was 34.8 kg and the mean BMI decrease was 8.6 kg/m2. Preoperative and postoperative IIEF scores of the 65 sexually active patients showed significant improvement in erectile function (21.2 ± 5.7 vs 26.5 ± 4.5; P = .02). Seventeen (20.7%) men were not sexually active preoperatively; only 5 became sexually active postoperatively. Men had a significant decrease in serum cholesterol and triglyceride levels. Nitric oxide synthase activity showed a significant increase (P < .02). In addition, our patients showed a statistically significant decrease in interleukin-6 levels and C-reactive protein compared with preoperative period (P < .03 and P < .01, respectively). Conclusion A significant improvement of erectile function was documented among obese young men undergoing LGS. This improvement was documented both clinically by improvement in IIEF score postoperatively and biochemically. A Fahmy, H Abdeldaiem, M Abdelsattar, et al. Impact of Bariatric Surgery on Sexual Dysfunction in Obese Men. Sex Med 2021;9:100322.
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Affiliation(s)
- Ahmed Fahmy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hussien Abdeldaiem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Abdelsattar
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer Aboyoussif
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdelrahman Zahran
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar Elgebaly
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Elgebaly OF, Abdeldaeim H, Abouyoussif T, Fahmy AM, Edris F, Zahran A, Assem A. 'Boxing in the corner': A modified retrograde approach for the management of proximal ureteric stones of 1-2 cm. Arab J Urol 2021; 19:141-146. [PMID: 34104488 PMCID: PMC8158186 DOI: 10.1080/2090598x.2021.1881421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To study a modification to the conventional retrograde ureteroscopic approach for treating proximal ureteric stones of 1–2 cm; we intentionally push the stone from the proximal ureter into a favourable calyx then the flexible ureteroscope is used to fragment the trapped stone using laser lithotripsy (‘boxing in the corner’). Patients and methods: The study was conducted in a randomised prospective manner and included 100 patients who presented with a single proximal ureteric stone of 1–2 cm. We randomised the patients into two equal groups: Group A (50 patients) underwent the conventional retrograde technique (CRT) and Group B (50 patients) underwent the modified retrograde technique (MRT) with the primary intention of relocating the stone into a favourable calyx. Intended relocation of the proximal ureteric stone in the MRT group was achieved in a stepwise manner. All intraoperative parameters and postoperative outcomes were recorded and compared between the two groups. Results: There was no statistical significant difference in terms of the patients’ demographics and stone criteria between the two groups. The stone-free rate (SFR) was significantly higher in Group B (92%) compared to Group A (78%) (P = 0.049). Fluoroscopy time was significantly longer in Group B (P < 0.001), while operative time, lithotripsy time and hospital stay were comparable. There was no difference between the groups regarding complications. Conclusion: The MRT was found to be safe and more effective than the CRT for treating proximal ureteric stones of 1–2 cm, with a significantly higher SFR. Abbreviations CONSORT: Consolidated Standards of Reporting Trials; ESWL: extracorporeal shockwave lithotripsy; fURS: flexible ureteroscope; NCCT: non-contrast CT; SFR: stone-free rate; YAG: yttrium-aluminium-garnet
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Affiliation(s)
- Omar Farid Elgebaly
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hussein Abdeldaeim
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer Abouyoussif
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Mahmoud Fahmy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Faisal Edris
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdelrahman Zahran
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Badawy H, Dawood W, Soliman AS, Fahmy A, Mahfouz W, Moussa A, Assem A, Aboulfotouh Eid A, Elsayed S, Gawan A, Hanno A, Youssef M. Staged repair of proximal hypospadias: Reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg 2020; 55:2710-2716. [PMID: 32854924 DOI: 10.1016/j.jpedsurg.2020.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Proximal hypospadias (PPH) repair is a challenge. Dilemma exists whether to do it in single or staged repair. Staged repair is our adopted procedure which was recently modified by Snodgrass into staged tubularized autograft repair (STAG), in which attention was given to ventral straightening of the penis together with some other technical details. Herein, we report our experience with STAG in a cohort of primary posterior hypospadias. PATIENTS AND METHODS In the period from 2011 to 2018 we operated 43 primary posterior hypospadias. Two principal surgeons (HB, MY) and multiple assistants operate children the same way, and data are recorded in a prospectively designed data base. In all children, inner prepuce graft was utilized, when curvature is more than 30 degrees, plate transection with or without ventral corporotomies were adopted. RESULTS Forty-three children with PPH and ventral curvature more than 30 degrees underwent first stage with median age 12 months (6-132 IQR16). Penile curvature was corrected by plate transection in 27 children (62.8%), ventral corporotomies in 16 children (37.2%). Graft take was successful in 90.7%, 4 children needed revision of fibrotic graft. Second stage was completed in 37 children, success was 56.8%, 21.6% fistula, 24.3% glanular dehiscence. Overall success after third surgery to correct complications was 78.4%. In a mean follow up of 3.2 years, we had recurrence of curvature in 2 children taking success rate to 72.9%. No meatal stenosis, no diverticulum, no stricture, no urethral dehiscence was encountered. Cosmetic appearance was excellent in follow up. CONCLUSION STAG achieves proper straightening of the penis and allows for reconstruction of a good urethra, yet urethrocutaneous fistula and glanular dehiscence remain the main complications. Follow up is important to address results of ventral corporotomies. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE Level IV case series with no comparison group.
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Affiliation(s)
- Haytham Badawy
- Department of Urology, University of Alexandria, Alexandria, Egypt.
| | - Waleed Dawood
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | | | - Ahmed Fahmy
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Waly Mahfouz
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Akram Assem
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | | | - Shaymaa Elsayed
- Department of Pediatrics, University of Alexandria, Alexandria, Egypt
| | - Ahmed Gawan
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Mohammed Youssef
- Department of Urology, University of Alexandria, Alexandria, Egypt
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Assem A, Abou Youssif T, Hamdy SM, Beltagy AM, Gozen AS. Role of sparing of puboprostatic ligaments on continence recovery after radical prostatectomy: a randomized controlled trial. Scand J Urol 2020; 55:22-26. [PMID: 33241757 DOI: 10.1080/21681805.2020.1849389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Sparing of puboprostatic ligaments (PPLs) during radical prostatectomy was introduced as a technique to improve urinary continence. This study aims to study the effect of sparing of PPLs during laparoscopic radical prostatectomy in terms of continence during the first 3 months. METHODS A total of 74 patients, diagnosed with clinically localized prostate cancer, were randomly assigned to two equal groups; PPLs division and sparing during LRP. Based on the number of daily used pads, both groups completed 3 months follow-up to assess continence recovery. The effects of age, preoperative total prostate-specific antigen (PSA) and clinical tumor stage on continence recovery were also studied. The study was registered and approved by the Ethics Committee of Alexandria University-Faculty of Medicine (Protocol No. 0201074). RESULTS Seventy-four patients were enrolled, with a mean age of 63.8 years. Baseline characteristics were comparable, except significantly higher mean PSA in the division group. Sixty patients were continent (0-1 pad/day) at 3 months follow-up. Continence was significantly better in the sparing than division group at 1 week after catheter removal (67.6% vs 40.5%, p = 0.01), at 1 month (73% vs 45.9%, p = 0.009) and 2 months (89.2% vs 51.4%, p = 0.0001). At 3 months follow-up, there was no significant difference between both groups (83.3% vs 78.4% for sparing and division groups, respectively; p = 0.28). Moreover, continence was significantly improved at 3 months compared to 1 week in both groups. CONCLUSION Sparing of puboprostatic ligaments during radical prostatectomy significantly improves postoperative early recovery of urinary continence.
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Affiliation(s)
- Akram Assem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer Abou Youssif
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Seif M Hamdy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad M Beltagy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ali Serdar Gozen
- SLK-Kliniken Urology Department, Heidelberg University, Heilbronn, Germany
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Badawy H, Soliman A, Moussa A, Youssef M, Fahmy A, Dawood W, Elmesiry M, Assem A, Elsayed S, Abulfotooh Eid A, Orabi S. Staged repair of redo and crippled hypospadias: analysis of outcomes and complications. J Pediatr Urol 2019; 15:151.e1-151.e10. [PMID: 30833176 DOI: 10.1016/j.jpurol.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Residual curvature, scarred or absent urethral plate, shortage of skin, and paucity of vascularized tissues and flaps are all obstacles to overcome during repair of redo and cripple hypospadias after failed reconstruction. Limited articles address the outcome of repair of these cases using different grafts. OBJECTIVE An analysis of outcomes and complications after the repair of redo and cripple hypospadias in a cohort of children operated by a single surgeon is presented, and data are retrieved from a prospectively designed database. STUDY DESIGN Thirty-one children with a median age of 96 months (18-216, interquartile range [IQR]: 78), who underwent previous surgeries three to five times, were operated in the period from late 2011 to August 2017 in a single center by a single surgeon (first author); the first-stage repair was performed by using an inner prepuce graft in three children and oral grafts in 28 children. Penile straightening by degloving and removal of ventral scarred tissues are followed by development of glanular wings and grafting of the ventral surface. RESULTS Eleven distal penile hypospadias and 20 posterior hypospadias were operated. First-stage repair was revised in three children; 25 children, eight distal and 17 posterior hypospadias, underwent second-stage repair with a median age of 84 months (18-216, IQR: 60). The success rate after the second-stage repair was 56% (14 children), and complications were encountered in 11 children in the form of penoscrotal fistulae in four, complete dehiscence in one, and glanular dehiscence in six children. After closure of fistulae, the overall success rate increased to 72%. Although complications were more common among children with posterior hypospadias (nine children) than children with distal hypospadias (two children), no statistical significance was reached (p = .234), with no effect of age on complications (p = .233), no effect of the position of the meatus on glanular dehiscence (p = .624), and no effect of age on glanular dehiscence (p = .114). CONCLUSION Repair of redo and crippled hypospadias using staged graft repair in children could be achieved with a satisfactory overall success rate of 72%. Glanular dehiscence is the main complication; however, it is not considered by parents of children in the series, necessitating intervention. The lowest complication rate is expected among those with a position of the meatus more distal, however, not proven statistically in the series.
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Affiliation(s)
- H Badawy
- Department of Urology, University of Alexandria, Egypt.
| | - A Soliman
- Department of Urology, University of Alexandria, Egypt
| | - A Moussa
- Department of Urology, University of Alexandria, Egypt
| | - M Youssef
- Department of Urology, University of Alexandria, Egypt
| | - A Fahmy
- Department of Urology, University of Alexandria, Egypt
| | - W Dawood
- Department of Urology, University of Alexandria, Egypt
| | - M Elmesiry
- Department of Urology, University of Alexandria, Egypt
| | - A Assem
- Department of Urology, University of Alexandria, Egypt
| | - S Elsayed
- Department of Pediatrics, University of Alexandria, Egypt
| | | | - S Orabi
- Department of Urology, University of Alexandria, Egypt
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Hashad MM, Abdeldaeim HM, Moussa A, Assem A, Youssif TMA. Bipolar vs monopolar resection of bladder tumours of >3 cm in patients maintained on low-dose aspirin: A randomised clinical trial. Arab J Urol 2017; 15:223-227. [PMID: 29071156 PMCID: PMC5651943 DOI: 10.1016/j.aju.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/23/2017] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm. PATIENTS AND METHODS A prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT). The primary endpoint of the study was the decrease in postoperative haemoglobin (Hb) concentration measured using an automated cell counter. The secondary endpoints of the study were intraoperative blood transfusion or the occurrence of urethral trauma during cystoscopy and the need for re-coagulation. RESULTS The postoperative reduction in Hb concentration, was significantly lower in the B-TURBT group [mean (SD) 0.55 (0.26) g/dL] compared with the M-TURBT group [mean (SD) 1.24 (0.61) g/dL] (P < 0.001). There was also a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit and the mean postoperative hospital stay. There was no significant difference between the groups for the occurrence of obturator jerk, bladder perforation, and the need for blood transfusion. CONCLUSION B-TURBT in patients maintained on low-dose aspirin is better than M-TURBT for minimising postoperative drop in Hb concentration.
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Affiliation(s)
| | | | - Ahmed Moussa
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Urology Department, Alexandria University, Alexandria, Egypt
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12
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Gözen AS, Badawy H, Teber D, Assem A, Rassweiler J. Outcome of laparoscopic upper pole heminephroureterectomy in children: A two-centre experience. Arab J Urol 2016; 14:287-291. [PMID: 27900219 PMCID: PMC5122799 DOI: 10.1016/j.aju.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report our multicentre experience and outcomes with laparoscopic transperitoneal and retroperitoneal upper pole heminephroureterectomy (HNU) in children with renal duplex systems and impaired upper pole. PATIENTS AND METHODS Laparoscopic HNU was performed in 22 children (15 girls, seven boys) with a mean age of 5.9 years. A retroperitoneal approach was used in 17 patients and a transperitoneal approach in the remaining five, between 2005 and 2010. Urinary tract infection was the initial presenting symptom in all children except for one with urinary retention caused by a large ureterocele. Voiding cystourethrography and renal scintigraphy revealed dual collecting systems on the right side in 11 and on the left in 11 cases. The upper pole collecting system was non-functioning in all cases. Postoperative ultrasonography was done at 1 and 3 months, with renal scintigraphy at 3 months, to check the remaining function of the lower moiety. RESULTS Overall, the mean operation time was 152 min (144 min for retroperitoneal and 160 min for transperitoneal). Blood loss was 10-50 mL and there were no intraoperative complications. The mean (SD) hospitalisation and postoperative follow-up were 3.5 (1.25) days and 22 (9.83) months, respectively. Postoperative recovery was uneventful and at the 3-month follow-up renal scintigraphy revealed no parenchymal loss of the remaining renal moiety. CONCLUSION Laparoscopic HNU in children can be performed via transperitoneal or retroperitoneal approach, both with low morbidity and with the typical benefits of laparoscopic surgery.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Dogu Teber
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Akram Assem
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
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Foda K, Abdeldaeim H, Youssif M, Assem A. Calculating the number of shock waves, expulsion time, and optimum stone parameters based on noncontrast computerized tomography characteristics. Urology 2013; 82:1026-31. [PMID: 24044913 DOI: 10.1016/j.urology.2013.06.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/27/2013] [Accepted: 06/06/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To define the parameters that accompanied a successful extracorporeal shock wave lithotripsy (ESWL), namely the number of shock waves (SWs), expulsion time (ET), mean stone density (MSD), and the skin-to-stone distance (SSD). METHODS A total of 368 patients diagnosed with renal calculi using noncontrast computerized tomography had their MSD, diameter, and SSD recorded. All patients were treated using a Siemens lithotripter. ESWL success meant a stone-free status or presence of residual fragments <3 mm, ET was the time in days for the successful clearance of stone fragments. Correlation was performed between the stone characteristics, number of SWs, and ET. Two multiple regression analysis models defined the number of SWs and ET. Two receiver operating characteristic curves plotted the best MSD cutoff value and optimum SSD for a successful ESWL. RESULTS Three hundred one patients were ESWL successes. A significant positive correlation was elicited between number of SWs and stone diameter, density and SSD; between ET and stone diameter and density. Multiple regressions concluded 2 equations: Number of SWs = 265.108 + 5.103 x1 + 22.39 x2 + 10.931 x3 ET (days) = -10.85 + 0.031 x1 + 2.11 x2 x1 = stone density (Hounsfield unit [HUs]), x2 = stone diameter (mm), and x3 = SSD (mm). Receiver operating characteristic curves demonstrated a cutoff value of ≤ 934 HUs with 94.4% sensitivity and 66.7% specificity and P = .0211. The SSD curve showed that a distance ≤ 99 mm was 85.7% sensitive, 87.5% specific, P <.0001. CONCLUSION Stone disintegration is not recommended if MSD is >934 HUs and SSD >99 mm. The required number of SWs and the expected ET can be anticipated.
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Affiliation(s)
- Khaled Foda
- Department of Urology, College of Medicine, University of Alexandria, Alexandria, Egypt.
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14
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Assem A, Hashad MM, Badawy H. Retroperitonoscopic pyelopexy for pelviureteral junction obstruction with crossing vessel in adolescents: Hellstrom principle revisited. J Pediatr Urol 2013; 9:415-8. [PMID: 23340214 DOI: 10.1016/j.jpurol.2012.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 12/09/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To present our new approach using a minimally invasive technique for the management of pelviureteral junction (PUJ) obstruction with a crossing vessel. MATERIALS AND METHODS In December 2009 to December 2011, out of 23 cases of retroperitoneoscopic laparoscopic pyeloplasty, four adolescents presenting with PUJ obstruction due to an aberrant crossing vessel, with intermittent attacks of renal colic and mild dilatation of the renal pelvis and calyces, were operated by retroperitoneoscopic pyelopexy. A retroperitoneoscopic approach was used in all patients using three trocars. After dissection of the PUJ from the anterior crossing vessel, and ensuring good funneling of the PUJ that proved to show mild dilatation, an interrupted 3/0 polyglycolic suture was used to fix the renal pelvis to the psoas muscle away from the crossing vessel (pyelopexy). A retrograde DJ stent was placed at the end of the procedure. RESULTS The four patients had a mean age of 18.25 years (16-20): 2 males and 2 females, two right sided and two left sided. Average operative time was 46 min (40-55). All patients were discharged on the same day. No intraoperative complications were encountered. The DJ stent was removed 6 weeks postoperatively. After a mean follow up of 2.125 years (6 months-3 years) no recurrences were observed. CONCLUSION Retroperitoneoscopic pyelopexy is shown to be a reliable, effective, safe and minimally invasive technique for the management of PUJ obstruction with a crossing vessel in selected cases. Long-term follow up is needed to assess any recurrence or development of complications.
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Affiliation(s)
- Akram Assem
- Department of Urology, University of Alexandria, Alexandria, Egypt.
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Badawy H, Orabi S, Assem A, Dawood W, Hanno A. 1612 EVALUATION OF SINGLE STAGE FEMINIZING GENITOPLASTY IN CHILDREN AND ADOLESCENTS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Badawy H, Assem A, Saad A, Hanno A, Elsalmy S. Retroperitonoscopic Nephrectomy and Nephrouretrectomy in Children and Adolescents: Analysis of a Single-Center Experience. J Endourol 2011; 25:809-13. [DOI: 10.1089/end.2010.0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haytham Badawy
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Akram Assem
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Ashraf Saad
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Salah Elsalmy
- Department of Urology, University of Alexandria, Alexandria, Egypt
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17
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Assem A, Salomon L, Hoznek A, Gillion N, Abbou CC, de la Taille A. 1304 VESICO-URETHRAL ANASTOMOSIS AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY; BARBED OR MONOFILAMENT SUTURE? J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Badawy H, Hashad M, Saad A, Assem A, Hanno A. VID-01.02: Retroperitonoscopic Pyeloplasty in Children and Adolescents: Presentation of Different Techniques. Urology 2009. [DOI: 10.1016/j.urology.2009.07.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Assem A, Elgebaly O, Moawad E, Hamdy S. UP-3.052: Early Experience with Thermoexpandable Memokath Prostatic Stent. Urology 2009. [DOI: 10.1016/j.urology.2009.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Badawy H, Saad A, Assem A, Eid A, Shaaran M, Aboyoussef T, Hanno A. VID-01.01: Laparoscopic Utilization of Intestinal Segments in the Management of Different Pediatric Genitourinary Diseases: Preliminary Report. Urology 2009. [DOI: 10.1016/j.urology.2009.07.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Assem A, Elgebaly O, Moawad E, Elazawy T, Hamdy S, Marzouk E. UP-1.081: The Use of Thermoexpandable Memokath Urethral Stent in Cases with Recurrent Penile and/or Bulbar Strictures. Urology 2009. [DOI: 10.1016/j.urology.2009.07.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Marzouk M, Elrefai A, Fouda K, Rashad H, Elazawy T, Assem A. VID-01.04: Sutureless Retroperitonoscopic Upper Tract Stone Extraction. Urology 2009. [DOI: 10.1016/j.urology.2009.07.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mokhless I, Gaafar S, Fouda K, Shafik M, Assem A. Botulinum A Toxin Urethral Sphincter Injection in Children With Nonneurogenic Neurogenic Bladder. J Urol 2006; 176:1767-70; discussion 1770. [PMID: 16945643 DOI: 10.1016/j.juro.2006.03.119] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE We evaluated botulinum-A toxin (Botox) injection into the urethral urinary sphincter in children with nonneurogenic neurogenic bladder to decrease urethral resistance and improve voiding. In these patients alpha-blocker medications had failed and injection was an alternative to unavailable biofeedback. MATERIALS AND METHODS Prospective treatment was performed in 10 children 6 to 17 years old (mean age 8) with nonneurogenic neurogenic bladder using botulinum-A toxin (Botox). Preoperatively all children were evaluated by ultrasound, voiding cystourethrography, excretory urography, magnetic resonance imaging and urodynamic studies, including pressure flow, electromyography and uroflowmetry. One patient had unilateral G3 reflux and 4 had bilateral G1 to G3 hydronephrosis. Using a rigid pediatric endoscope and a 4Fr injection needle 50 to 100 IU botulinum-A toxin were injected into the external sphincter at the 3, 6 and 9 o'clock positions. Followup was 6 to 15 months. Repeat injections every month were given according to the response with a maximum of 3 injections. RESULTS Immediately after botulinum-A toxin injection all except 1 patient were able to void without catheterization. No acute complications occurred. Four patients with bilateral hydronephrosis and the patient with the refluxing unit showed regression. Postoperatively post-void residual urine decreased by 89%, detrusor leak point pressure decreased significantly by a mean +/- SD of 66 +/- 18 vs 37 +/- 4 cm H(2)O and uroflowmetry showed a marked increase in maximum urine flow of 2 +/- 2 vs 17.8 +/- 8 ml per second. Three injections were needed in 1 patient to attain the desired response. CONCLUSIONS Urethral sphincter botulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.
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Affiliation(s)
- I Mokhless
- Department of Urology, Section Pediatric Urology, Alexandria University, 21 Amin Fikery, Ramleh Station, Alexandria, Egypt.
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Kadiri A, Al-Nakhi A, El-Ghazali S, Jabbar A, Al Arouj M, Akram J, Wyatt J, Assem A, Ristic S. Treatment of type 1 diabetes with insulin lispro during Ramadan. Diabetes Metab 2001; 27:482-6. [PMID: 11547222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To compare insulin lispro with regular human insulin with respect to blood glucose control and frequency of hypoglycaemia in patients with type 1 diabetes who wished to fast during the month of Ramadan. RESEARCH DESIGN AND METHODS Insulin lispro or regular human insulin was given together with NPH insulin, twice daily before the morning and evening meals, for two weeks each in an open-label, randomised, cross-over design, and 64 patients completed the protocol. Blood glucose was self-monitored at fasting morning and evening, and 1-h and 2-h after the post-sunset meal on three consecutive days at the end of each treatment period. RESULTS The 2-h blood glucose excursion after the post-sunset meal was significantly (p=0.026) lower with insulin lispro (2.50 +/- 0.46 mmol/l) than with regular human insulin (3.47 +/- 0.49 mmol/l). Daily insulin doses did not differ between treatments but compliance with recommended time of injection was better with insulin lispro. Hypoglycaemia incidence (insulin lispro, 15 (23.4%) patients; regular human insulin 31 (48.4%) patients; p=0.004) and frequency (insulin lispro, 0.70 +/- 0.19; regular human insulin 2.25 +/- 0.36 episodes/patient/30 days; p<0.001) were lower with insulin lispro. Five (22.7%) of the episodes during insulin lispro occurred during the nocturnal period compared with 27 (36.5%) of the episodes while on regular human insulin. CONCLUSIONS Glycaemic control, measured by postprandial glycemic excursions, was improved and hypoglycaemia was significantly reduced with insulin lispro compared with regular human insulin. Patients with type 1 diabetes who insist on fasting during Ramadan may be better managed with insulin lispro.
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Affiliation(s)
- A Kadiri
- Service d'Endocrinologie, Chu Ibn Sina Rabat, Morocco
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Ouadfel J, Assem A, Jalil A, Balafrej S. [Treatment of the perforated duodenal ulcer. A personal series of 188 cases]. Tunis Med 1990; 68:663-5. [PMID: 2082518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J Ouadfel
- Service des Urgences Chirurgicales Viscérales (U.C.V.) Pr. S. Balafrej CHU Avicenne Rabat Maroc
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el Allame L, Ouadfel J, Assem A, Balafrej S. [Encapsulating peritonitis. Report of 2 cases]. J Chir (Paris) 1990; 127:416-9. [PMID: 2229217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Walled-off peritonitis which is a frequent occurrence in patients treated by continuous ambulatory peritoneal dialysis may also occur in cases where there is no obvious pathological factor. This was the case in the two patients reported. Both were male patients aged 28 and 32 years hospitalised and operated on for acute intestinal obstruction. Positive diagnosis was made at the time of operation. Decortication with total enterolysis was performed in the two cases. However, a jejunal fistula with a favorable outcome occurred in one case, investigation for acid fast bacilli was negative and histological examination was non specific.
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Affiliation(s)
- L el Allame
- Service des Urgences Chirurgicales Viscérales, CHU Avicenne, Rabat, Maroc
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Ouadfel J, Assem A, Jalil A, el Allame L, Benjelloun S, Chkoff L, Balafrej S. [Eosinophilic fasciitis (Shulman's syndrome): apropos of a case report]. Tunis Med 1990; 68:147-9. [PMID: 2330618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J Ouadfel
- Service des Urgences Chirurgicales Viscérales, C.H.U. Avicenne Rabat Maroc
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Ouadfel J, Assem A, el Allame L, Mechatt F, Chkoff R, Benchekroun A, Errougani A, Harraki T, Nejmi M, Balafrej S. [Fatal appendectomy caused by postoperative gas gangrene of the abdominal wall. 2 cases]. J Chir (Paris) 1989; 126:608-10. [PMID: 2584291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The authors report two cases of post-appendicectomy gas gangrene with a fatal outcome. Based on the study of these two cases they analyse the incidence, mechanism and prognosis of this serious post-operative complication. They stress the prophylactic measures necessary for prevention.
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Affiliation(s)
- J Ouadfel
- Service des Urgences Chirurgicales Viscérales, CHU Avicenne, Rabat, Maroc
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Ouadfel J, Assem A, Jalil A, Chkoff R, el Allame L, Mechatt F, Benchekroun A, Errougani A, Balafrej S. [2 cases of the diffuse form of Caroli disease]. Acta Chir Belg 1989; 89:233-6. [PMID: 2800861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Report of two cases. The authors report two observations in what concern the diffused form of the Caroli's disease, one pure, the other mixed associating the congenital dilatation of the intra-hepatic bileducts with lesion of congenital hepatic fibrosis. They emphasize the efficiency of the echographia and computed tomography in diagnosing Caroli's disease. The surgical treatment of these diffused forms often complicated by acute recurrent cholangitis used with some success various methods of biliary drainage. But the radical treatment seems to be obliged to turn itself more likely toward liver transplantation.
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Affiliation(s)
- J Ouadfel
- Service des Urgences Chirurgicales Viscérales, CHU Avicenne Rabat Maroc
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30
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el Allame L, Belkhayat S, Chkoff L, Mechatt F, Chkoff MR, Benchkroun BA, Assem A, Balafrej A, Sebti F, Balafrej S. [Spontaneous hemoperitoneum complicating intraperitoneal paraganglioma]. J Chir (Paris) 1989; 126:242-7. [PMID: 2659610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A young man of 27 years was admitted to the medical ward because of increasing ascites over 3 months. There were no signs of portal hypertension and a diagnostic tap produced hemorrhagic liquid. Ultrasound confirmed ascites associated with an abdomino-pelvic mass. Anemia progressed and right aorto-iliac axis arteriography was carried out and demonstrated a poorly vascularised mass. Emergency surgery was carried out and demonstrated an encapsulated firm and cystic abdomino-pelvic mass of 23/18 cm with a rich vascular supply from the greater omentum and a hemoperitoneum of 7 litres secondary to rupture of this pseudo-lymphangiomatous mass. Besides large vessels from the and some loose fibrous adhesions in the pouch of Douglas there was no true implantation site attaching this mass to retroperitoneal structures, gastrointestinal tract or bladder. After ligation of the vessels the entire mass was easily resected. The post-operative course was uncomplicated. Pathological examination confirmed a paraganglioma. A full clinical pathogenic, therapeutic and evolutive study is described.
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Affiliation(s)
- L el Allame
- Urgences Chirurgicales Viscérales, C.H.U., Hôpital Avicenne, Rabat - Maroc
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Jirari M, Assem A, Derfoufi M, Hermas M, Yacoubi S, El Otmani M, El Manouar M, Ismail A. [Recent acromioclavicular joint dislocations]. Maghrib Tibbi 1983; 5:142-9. [PMID: 6674699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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