Publications by authors named "Mohamed H Zahran"

34 Publications

Omega-3 polyunsaturated fatty acids: a modified approach for chemo-prevention of bladder cancer in a rat model and molecular studies of antineoplastic mechanisms.

Mol Biol Rep 2022 Jul 25;49(7):6357-6365. Epub 2022 Apr 25.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objectives: To test the chemo-preventative effects of omega-3 against bladder cancer (BC) induction in a rat model and its potential antineoplastic mechanisms.

Material And Methods: Ninety male Fisher rats were divided into three groups during a 22-week protocol: group 1 (control), group 2 (Placebo + N-butyl-N-4- hydroxybutyl nitrosamine (BBN) for induction of BC and group 3 received omega-3 (1200 mg/kg/day) + BBN. At the end, blood samples and bladder tissues were collected and checked for the presence of malignancy, markers of angiogenesis (VEGF relative gene expression), inflammation (IL-6), proliferation (KI-67 expressions), oxidative stress (serum MDA and serum SOD) and epigenetic control (miRNA-145 level).

Results: At the end of the study, 60% and 86.6% rats survived in group 2 and 3 with significant weight loss among rats in group 2 when compared with other groups. In group 2, all rats developed visible bladder lesions of which five and 13 developed squamous cell carcinoma (SCC) and transitional cell carcinoma (TCC). In omega3-treated group, only one developed low grade SCC and one developed high grade non- invasive TCC. Bladders from omega-3-treated rats showed lower expression ofKI-67 (p < 0.05), VEGF (p < 0.001) and IL-6 (p < 0.001) and significant higher expression of mi-RNA (p < 0.001). Also, omega-3-treated group showed statistically significant lower MDA level (p < 0.001).

Conclusion: Omega-3 inhibits bladder tumor growth in the BBN-induced BC rat model, due to anti-inflammatory, antioxidant, anti-proliferative, and anti-angiogenic properties together with epigenetic control.
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http://dx.doi.org/10.1007/s11033-022-07445-7DOI Listing
July 2022

Baicalein and Αlpha-Tocopherol Inhibit Toll-like Receptor Pathways in Cisplatin-Induced Nephrotoxicity.

Molecules 2022 Mar 28;27(7). Epub 2022 Mar 28.

Department of Chemistry, College of Science, King Faisal University, Al-Ahsa 31982, Saudi Arabia.

Cisplatin (CP) is a conventional chemotherapeutic agent with serious adverse effects. Its toxicity was linked to the stimulation of oxidative stress and inflammation. As a result, this study explored the protective effect of baicalein and alpha-tocopherol in nephrotoxicity induced by cisplatin. Until receiving an intraperitoneal injection of CP (3 mg/kg BW), rats were given baicalein orally 100 mg/kg for seven days or/and a single intraperitoneal injection of α-tocopherol 250 mg/kg. Renal function was tested to explore whether baicalein and α-tocopherol have any beneficial effects; blood urea nitrogen (BUN), serum creatinine, malondialdehyde (MDA) content, antioxidant activity biomarkers and histopathology of renal tissue, oxidative stress biomarkers, inflammatory response markers, and histopathological features of kidney architecture were measured. Cisplatin treatment resulted in extreme renal failure, as measured by high serum creatinine and BUN levels and severe renal changes. Cisplatin therapy resulted in increased lipid peroxidation and decreased glutathione and superoxide dismutase levels, reflecting oxidative stress. Upon treatment with α-tocopherol, baicalein, and combined therapy, there was augmentation in the antioxidant status as well as a reduction in IL-6, NF-κB, TNF, TLR2, and TLR4 and a significant increase in Keap-1 and NRF-2. The combined treatment was the most effective and the nearest to the normal status. These findings suggest that baicalein and α-tocopherol may be useful in preventing cisplatin-induced nephrotoxicity.
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http://dx.doi.org/10.3390/molecules27072179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9000769PMC
March 2022

The Effect of Renal Transplantation on Female Sexual Function: An Age-Matched Pair Analysis.

Urology 2022 Jul 31;165:164-169. Epub 2022 Jan 31.

Department of Urology, Urology and nephrology center, Mansoura University, Mansoura, Egypt.

Objective: To evaluate female sexual function (FSF) after renal transplantation (RT) and compare it to an age-matched normal females (control).

Material And Methods: The study included 100 sexually active RT females in child-bearing period. Sexual function was evaluated with Female Sexual Function Index (FSFI). We compared the mean scores of all domains of FSFI to an age-matched sexually active normal females. Also, we compared the current FSFI to the pre-transplant status in 54 married females before RT. Factors affecting the FSF after RT were assessed.

Results: In comparison to control group, RT group had statistically significant lower sexual desire (P <.001) with no significant differences as regard arousal, lubrication, orgasm, satisfaction, pain, and total FSFI score (P >.05). Among RT-females, 83% had normal sexual function, and 83.7% of the control had normal sexual function (P = .8). After RT, the FSFI score increased significantly from 20.7 ± 5.4 to 27.8 ± 3.1 (P <.001), and 85.2% had normal sexual function compared to 22.2% before RT (P <.001) with statistically significant improvement in all domains (P <.001) except for pain score (P = .8). Female circumcision was the only identified factor associated with FSD (P = .02).

Conclusion: Successful RT significantly improves female sexual function of ESRD patients. The sexual function after RT is comparable to healthy control except for lower sexual desire.
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http://dx.doi.org/10.1016/j.urology.2022.01.029DOI Listing
July 2022

Mirabegron for treatment of erectile dysfunction concomitant with lower urinary tract symptoms in patients with benign prostatic obstruction: A randomized controlled trial.

Int J Urol 2022 05 18;29(5):390-396. Epub 2022 Jan 18.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objective: To assess the efficacy of mirabegron in the treatment of erectile dysfunction concomitant with lower urinary tract symptoms in benign prostatic obstruction patients.

Methods: In this randomized controlled trial, 55 sexually active lower urinary tract symptoms/benign prostatic obstruction patients with concomitant erectile dysfunction were randomly allocated in two groups: the first received mirabegron 50 mg plus doxazosin 2 mg once daily (mirabegron group) and the second received tolterodine 4 mg plus doxazosin 2 mg (tolterodine group) for 12 weeks. The evaluation was based on the International Index of Erectile Function questionnaire, Erection Hardness Score questionnaire, International Prostate Symptom Score, quality of life, uroflowmetry and post-voiding residual. The therapeutic outcomes were assessed at 4 and 12 weeks compared with the baseline.

Results: Only the mirabegron group achieved significant improvement in sexual functions after 4 and 12 weeks. By using ≥5 points difference from the baseline as a cut-off point of change, there was a significant difference in change of direction of the International Index of Erectile Function-15 total score in favor of the mirabegron group; after 12 weeks, the International Index of Erectile Function-15 total score decreased in 0%, was unchanged in 8.3% and improved in 91.7% in the mirabegron group compared with 8.7%, 65.2% and 26.1%, respectively, in the tolterodine group (P < 0.001). Regarding the urinary characteristics, both groups showed significant improvement in the International Prostate Symptom Score, quality of life, and post-voiding residual after 4 and 12 weeks, with no significant difference among them.

Conclusion: Mirabegron improves urinary characteristics and the associated sexual dysfunction in patients with lower urinary tract symptoms/benign prostatic obstruction.
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http://dx.doi.org/10.1111/iju.14792DOI Listing
May 2022

Identification of Different miRNAs and Their Relevant miRNA Targeted Genes Involved in Sister Chromatid Cohesion and Segregation (SCCS)/chromatin Remodeling Pathway on T1G3 Urothelial Carcinoma (UC) Response to BCG Immunotherapy.

Clin Genitourin Cancer 2022 06 16;20(3):e181-e189. Epub 2021 Dec 16.

Center of Excellence for genome and cancer research, Urology and Nephrology Center, Mansoura University, Egypt.

Background: Till now, no definite clinical or laboratory marker can predict the recurrence or progression of T1 G3 urothelial carcinoma (UC). Genetic aberrations of the chromatin remodeling genes and sister chromatid cohesion and segregation (SCCS) were identified in UC. Here we investigated the impact of novel miRNAs and their targeted expressed SCCS and chromatin remodeling genes on T1G3 UC response to Bacillus Calmette-Guérin (BCG) therapy.

Methods: One hundred tissue samples were obtained from NMIBC patients. Gene expression and immunohistochemical assay of STAG2, ARID1A, NCOR1and UTX were assessed. MiRNA analysis for their targeting miRNAs (miR-21, miR-31, Let7a and miR-199a) was carried out. Assessed genes were compared between responders and no responders to BCG. Univariate and multivariate analysis of predictors of disease recurrence and progression were performed using cox regression analysis.

Results: Thirty-two and 22 patients developed recurrence and progression to MIBC (BCG non-responders). BCG non-responders showed statistically significant higher expression of miR-21 and their targeted STAG2, miR-199a and NCOR1 gene (P < .001), and lower expression of miR-31, Let7a, ARID1A and UTX genes (P < .001). Higher miR-199a (P = .006) and lower miR-31 (P = .01), ARID1A (P = .008) and UTX (P = .03) were independent predictor of higher tumor recurrence. Recurrent disease (P = .003), higher expression of STAG2 (P = .01), NCOR1 (P = .01) and miR-21 (P = .03) genes and lower expression of miR-31 (P = .02), Let7a (P = .04) and ARID1A (P = .04) genes were the independent predictor of disease progression.

Conclusion: Upregulation of STAG2 and NCOR1 and down regulation of ARID1A and UTX genes and their targeting miRNAs were associated with UC non-response to BCG.
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http://dx.doi.org/10.1016/j.clgc.2021.12.001DOI Listing
June 2022

Predictive value of immunological markers after bacille Calmette-Guérin induction in bladder cancer.

BJU Int 2021 Aug 27. Epub 2021 Aug 27.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objectives: To investigate the predictive value of different immunological markers on treatment outcomes after bacille Calmette-Guérin (BCG) induction in high-risk non-muscle-invasive bladder cancer (NMIBC).

Patients And Methods: Patients who underwent transurethral resection of bladder tumour for NMIBC were assessed for study eligibility. Urine and blood samples were taken from patients at baseline (immediately before first dose of induction) and after induction (4 h after last [sixth] dose). Urine samples were evaluated for interleukin (IL)-2 and IL-10 by solid-phase enzyme-linked immunosorbent assay. Blood samples were evaluated for tumour necrosis factor α (TNF-α), cytotoxic T-lymphocyte antigen 4 (CTLA-4) and transcription factors (TFs) (GATA-binding protein 3 [GATA3], T-box expressed in T cells [T-bet], and forkhead box protein 3 [FoxP3]) using quantitative reverse transcriptase-polymerase chain reaction analysis. Change pattern and fold change of each evaluable marker was assessed in relation to different treatment outcomes (initial complete response [ICR]/recurrence/progression).

Results: Between July 2013 and May 2019, 204 patients were included. Among evaluable markers, urinary IL-2 and serum TNF-α increased in all patients, serum CTLA-4 and FoxP3 showed a predominant decreased pattern in 188 (92.2%) and 192 (94.1%) patients, respectively. An ICR was achieved in 186 (91.2%) patients. Serum TNF-α fold change and urinary IL-10 change pattern were significantly associated with an ICR (P = 0.001 and P = 0.03, respectively). At a median (range) follow-up of 37 (20-88) months, 104 (56%) patients developed recurrence. Urinary IL-10, serum CTLA-4, T-bet , FoxP3 change patterns and GATA3 /T-bet ratio were significantly associated with tumour recurrence (P = 0.001, P = 0.001, P = 0.02, P = 0.009 and P = 0.001, respectively). Tumour progression occurred in 34 (18.3%) patients. Urinary IL-10, serum CTLA-4, serum T-bet change patterns and GATA3 /T-bet ratio were independent predictors of tumour progression (P = 0.001, P = 0.001, P = 0.02 and P = 0.001, respectively).

Conclusions: Urinary IL-10 and serum TNF-α can significantly predict ICR. Moreover, change pattern of urinary IL-10, serum CTLA-4, TFs (GATA3, T-bet and FoxP3) and GATA3 /T-bet ratio after BCG induction can independently predict further BCG response. These markers could be implemented in clinical practice when management options are discussed or in systems with severe BCG shortage.
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http://dx.doi.org/10.1111/bju.15582DOI Listing
August 2021

5-Year Long-Term Outcome of Live-Donor Renal Transplant Recipients With Enterocystoplasty and Ureterocystoplasty: An Age- and Sex-Matched Pair Analysis.

Urology 2021 03 20;149:234-239. Epub 2020 Dec 20.

Urology department, Urology and nephrology center, Mansoura University, Egypt.

Objective: To assess surgical complications, febrile UTI, graft function and 5-year graft survival after renal transplantation (RT) in patients with augmentation cytsoplasty (AC) and to compare them to RT patients with normal lower urinary tract.

Materials And Methods: A case-control study of 34 RT patients with AC including 23 patients with enterocystoplasty (EC) and 11 patients with ureterocystoplasty (UC) was performed. The primary outcome was to determine the difference between both groups regarding postoperative surgical complications and febrile UTI episodes. Graft function was compared at 1, 3, and 5 years and 5-year graft survival was determined. The secondary outcome was to compare them to an age- and gender-matched control group (122 patients) with normal lower urinary tract.

Results: There was no significant difference regarding surgical complications or rates of hospital readmission between AC groups. Seventeen (73.9%) and 5 (45.5%) patients developed 33 and 14 episodes of febrile UTI in EC and UC groups, respectively (P= .5). Control group had shown lower incidence surgical complications (P = .001) and febrile UTIs (P = .02) compared to AC groups. At 3 and 5 years, UC had higher median eGFR than EC (P = .08, 0.008, respectively). The 5-year graft survival was 32 (94.1%) with no statistically significant difference between EC (95.7%) and UC (90.9%) (P = .5) or between AC and control (85.2%, P = .3).

Conclusion: Although RT after AC was associated with higher surgical complications and UTI episodes, they had comparable 5-year graft survival to their control. When indicated, UC should be the preferred choice of AC whenever possible.
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http://dx.doi.org/10.1016/j.urology.2020.12.006DOI Listing
March 2021

Parastomal hernia after ileal conduit urinary diversion: re-visiting the predictors radiologically and according to patient-reported outcome measures.

Scand J Urol 2020 Dec 16;54(6):501-507. Epub 2020 Oct 16.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Purpose: To evaluate the predictors of post-ileal conduit (IC) parastomal hernia (PSH) based on a standard grading methodology and according to the patients reported outcome measures (PROM).

Methods: A prospective evaluation for patients with IC attending their scheduled follow-up was conducted between December 2013 and October 2015. The hernia stage was determined according to the European Hernia Society (EHS) classification as types I and II included defect size 5 cm without and with a concomitant incisional hernia, respectively. Types III and IV included defect size > 5 cm without and with a concomitant incisional hernia (high-grade hernia). The evaluation was performed by a non-contrast CT scan. PROM were defined as symptomatic if there were hernia-related abdominal discomfort, appliance problems, and/or bowel complications. Perioperative parameters were modeled for prediction of high-grade and PROM outcomes.

Results: PSH was diagnosed in 138 (39.9%) patients, symptomatic in 119 (34.4%) and high-grade in 59 (17%). Independent predictors of radiologically diagnosed PSH were hypoalbuminemia (odds ratio [OR]: 1.7; 95% Confidence interval [CI]: 1.1-2.7;  = 0.02), localised disease (OR: 0.6; 95% CI: 0.3-0.9;  = 0.04) and negative lymphadenopathy (OR: 0.4; 95%CI: 0.2-0.8;  = 0.004). Predictors of symptomatic PSH were hypoalbuminemia (OR: 2; 95%CI: 1.2-2.3:  = 0.003) and previous hernia surgery (OR: 2.1; 95%CI: 1.1-4.2;  = 0.024).

Conclusions: Only a small proportion of patients with PSH were asymptomatic. Preoperative hypoalbuminemia was the most significant factor contributing to the development and symptomatizing of PSH. Previous hernia surgery further contributed to the patient complaint.
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http://dx.doi.org/10.1080/21681805.2020.1832144DOI Listing
December 2020

Low energy shock wave-delivered intravesical botulinum neurotoxin-A potentiates antioxidant genes and inhibits proinflammatory cytokines in rat model of overactive bladder.

Neurourol Urodyn 2020 11 22;39(8):2447-2454. Epub 2020 Sep 22.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Purpose: To study the effect of intravesical instillation of botulinum neurotoxin-A (BoNT-A) combined with low energy shock wave (LESW) for treatment of overactive bladder (OAB) in a rat model and to investigate its effect on the associated inflammatory and oxidative stress process.

Material And Methods: Forty rats were subdivided into four equal groups: normal control group, OAB group, LESW group, and BoNT-A plus LESW group. Cystometrogram (CMG) changes and histopathological changes in the bladder mucosa were assessed in the different groups. Oxidative stress markers (malondialdehyde [MDA] and superoxide dismutase [SOD]) and proinflammatory cytokines (tumor necrotic factor-α [TNF-α] and interleukin-6 [IL-6]) were compared among groups.

Results: BoNT-A plus LESW group showed statistically significant lower amplitude (p = .001) and lower frequency of detrusor contractions (p = .01) compared to LESW, which showed no statistically significant difference in comparison to the OAB group. Also, the combined group significantly reduced submucosal edema and inflammatory cell infiltrate scores compared to all groups (p < .05). LESW was associated with 42% reduction of MDA expression while, LESW plus BoNT-A decreased it by 68% (p < .001). Also, LESW and LESW plus BoNT-A increased SOD expression by 43% and 75%, respectively (p < .001). LESW plus BoNT-A was associated with statistically significant lower expression of TNF-α and IL-6 expression by 37% and 66% in comparison to LESW group (p = .001).

Conclusion: Intravesical instillation of BoNT-A plus LESW is an effective method for increasing the urothelial permeability to BoNT-A and enhancing its therapeutic effect against OAB in rat model through the expression of a substantial anti-inflammatory and antioxidative stress effect.
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http://dx.doi.org/10.1002/nau.24511DOI Listing
November 2020

chromophobe renal cell carcinoma in the graft three decades after renal transplantation in a patient with a history of three renal transplants.

Saudi J Kidney Dis Transpl 2020 Jan-Feb;31(1):271-275

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

De novo renal allograft tumors were reported sporadically. Most of them were small, low-grade, and papillary renal cell carcinoma (RCC) type. A 46-year-old male presented with hematuria three decades after the first transplant. The patient had a history of three renal transplants. A tumor (12 cm × 13 cm) was diagnosed in the nonfunctioning first transplanted kidney. Radical nephrectomy of the graft harboring the tumor with preservation of the adjacent functioning graft was done and identified to be chromophobe RCC. After two-year follow-up, the patients had a perfect graft function with no evidence of oncological failure. We suggest that allograft tumor be considered in patient evaluation for hematuria. Regular follow-up imaging of transplanted kidney is mandatory even after graft failure for early detection of graft tumors.
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http://dx.doi.org/10.4103/1319-2442.279952DOI Listing
January 2021

Delivery of intravesical botulinum toxin A using low-energy shockwaves in the treatment of overactive bladder: A preliminary clinical study.

Arab J Urol 2019 15;17(3):216-220. Epub 2019 May 15.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

: To evaluate the efficacy and safety of botulinum toxin A (BoNT-A) instillation in the bladder under the effect of low-energy shockwaves (LESWs) for the treatment of refractory idiopathic overactive bladder (OAB). : A preliminary clinical study was conducted, including 15 patients with refractory OAB, between September 2016 and July 2017. Intravesical instillation of 100 IU of BoNT-A was done followed by LESWs (3000 shocks over 10 min) exposure to the supra-pubic area. Patients were followed-up by urine analysis, urine culture, post-void residual urine volume (PVR), and Overactive Bladder Symptom Score (OABSS) at 1, 2 and 3 months. : There were statistically significant improvements in all OABSS domains and the total score after 1 and 2 months of treatment ( < 0.05). Whereas, only the nocturia domain remained significantly improved after 3 months ( = 0.02). There was no significant increase in PVR throughout the study period ( > 0.05) and none of the patients required clean intermittent catheterisation. Two, two and three patients developed urinary tract infections after 1, 2 and 3 months, respectively. : Intravesical instillation of BoNT-A and LESWs is safe and effective method for the treatment of refractory OAB with a durable response for 2 months. BoNT-A: botulinum toxin A; CIC: clean intermittent catheterisation; DO: detrusor overactivity; LESWs: low-energy shockwaves; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score; Q: maximum urinary flow rate; QoL: quality of life; UUI: urgency urinary incontinence.
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http://dx.doi.org/10.1080/2090598X.2019.1605676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711027PMC
May 2019

Renoprotective effect of local sildenafil administration in renal ischaemia-reperfusion injury: A randomised controlled canine study.

Arab J Urol 2019 18;17(2):150-159. Epub 2019 Apr 18.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

: To design a new canine model to assess the renoprotective effect of local sildenafil administration, as the renoprotective effect of systemic sildenafil administration in renal ischaemia-reperfusion (IR) injury in animal models has been shown but its local effects have not been established to date. : In all, 120 dogs were assigned to five groups: sham, oral control (OC) group (right nephrectomy + left renal ischaemia for 60 min), oral sildenafil (OS) group (oral sildenafil 1 mg/kg, 60 min before ischaemia), local control (LC) group (local renal perfusion with saline and heparin for 5 min) and local sildenafil (LS) group (perfusion with sildenafil 0.5 mg/kg). Renal functions, histopathological changes, expression of caspase-3, nuclear factor erythroid 2-related factor 2 (Nrf2), inflammatory cytokines (intracellular adhesion molecule 1, tumour necrosis factor α and interleukin 1β) and endothelial nitric oxide synthase (eNOS) in renal tissues were assessed in all groups at 1, 3, 7 and 14 days. : There were significant improvements in renal functions and cortical and medullary damage scores in the sildenafil-treated groups compared to their control groups ( < 0.05). Also, the LS group showed significantly better improvement of renal functions and cortical and medullary damage scores than the OS group ( < 0.05). Moreover, sildenafil significantly decreased the expression of caspase-3 and inflammatory cytokines and increased the expression of Nrf2 and eNOS in renal tissue, which were statistically significant in the LS group. : LS has a greater renoprotective effect against renal IR injury than systemic administration via anti-inflammatory, antioxidant and anti-apoptotic pathways. : BUN: blood urea nitrogen; Ct: cycle threshold; eNOS: endothelial nitric oxide synthase; GAPDH: glyceraldehyde 3-phosphate dehydrogenase; H&E: haematoxylin and eosin; IL-1β: interleukin 1β; NO: nitric oxide; Nrf2: nuclear factor erythroid 2-related factor 2; OC: oral control; OS: oral sildenafil; LC: local control; LS: local sildenafil.
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http://dx.doi.org/10.1080/2090598X.2019.1600995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600067PMC
April 2019

Outcome of Live-Donor Renal Transplants With Incidentally Diagnosed Renal Angiomyolipoma in the Donor.

Transplant Proc 2019 Jul - Aug;51(6):1773-1778. Epub 2019 Jun 27.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Introduction: Accepting donors with renal lesion amenable for pre-transplant management with no suspected long-term harm seems to expand the live-donor pool. We aimed to assess the long-term outcome of live-donor renal transplantation with incidentally discovered renal angiomyolipoma (AML) during routine evaluation of donors.

Patients And Methods: A retrospective evaluation of incidentally discovered AML, during live-related-donor evaluation, was performed. The tumor criteria were retrieved. In cases with exophytic tumor, a back-table, partial nephrectomy was done with frozen section to exclude malignancy. Endophytic lesions were kept in situ and transplanted. Both donor and recipient were followed up by periodic imaging.

Results: Among 2925 cases, 6 AML with a median volume of 0.96 (range, 0.5-2) cm were identified. The median recipients' age was 21 (range, 10-38) years and the median donors' age was 48 (range, 45-50). Two AML were exophytic and back-table partial nephrectomy was performed, while 4 were endophytic and kept in situ, and the kidney was transplanted. After a median follow-up of 82 (range, 25-150) months, 4 patients were alive with functioning grafts and 2 resumed hemodialysis 5 and 7 years after transplantation. There was no evidence of increase in the AML size or newly developed AML in the grafts. All donors were alive with normal renal function (mean ± standard deviation, serum creatinine was 0.9 ± 0.2 mg/dL) and none developed new AML in the remaining kidney.

Conclusion: Incidentally discovered AML during live-donor evaluation is not a contraindication of donation after proper counseling of the couples and regular, periodic follow-up.
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http://dx.doi.org/10.1016/j.transproceed.2019.02.035DOI Listing
November 2019

The short-term effects of tolterodine on nocturnal incontinence after ileal orthotopic neobladder: a randomised crossover placebo-controlled study.

BJU Int 2019 Apr 4. Epub 2019 Apr 4.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objectives: To assess the effect of tolterodine in the treatment of nocturnal urinary incontinence (NUI) after ileal orthotopic neobladder (ONB).

Patients And Methods: This is a prospective randomised placebo-controlled crossover study (clinicaltrials.gov: NCT02877901). Patients with NUI after ONB were randomly allocated into two equal groups. Group T received 4 mg extended-release tolterodine at bed-time and Group P received placebo for 4 weeks followed by 2 weeks of washout, then crossed over to the alternate therapy for 4 weeks. Patients were assessed by the number of pads used per night (PPN) and with the Arabic version of the International Consultation on Incontinence Modular Questionnaire-Short Form (ICIQ-SF) at both phases of the study. The outcomes were the rate of NUI improvement and medication adverse events.

Results: Out of 172 patients, 150 and 122 patients were evaluated at both phases of the study. The mean ICIQ-SF scores and PPN were significantly decreased in Group T compared to Group P in both study phases (P < 0.001). In Group T, 15 (10%) and 11 (9%) patients became dry after the first allocation and crossover, respectively. In Group T, 60 (77.9%) patients reported improvement vs four (5.5%) in Group P (P < 0.001) after the first allocation. Similarly, 46 (73%) and seven (11.9%) patients showed improvement in groups T and P after the crossover, respectively (P < 0.001). Dry mouth occurred in 31 (20.8%) patients.

Conclusions: Tolterodine seems to be a good choice for treatment of NUI after radical cystectomy and ONB. However, further studies are needed to delineate the long-term effects and the associated urodynamic characteristics.
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http://dx.doi.org/10.1111/bju.14769DOI Listing
April 2019

Simultaneous peritoneal and retroperitoneal splenosis mimics metastatic right adrenal mass.

Int J Surg Case Rep 2018 5;49:30-33. Epub 2018 Jun 5.

Urology and Nephrology Center, Mansoura University, Egypt.

Introduction: Right retroperitoneal splenosis is rare with few reported cases. We report, here, the case of simultaneous peritoneal and retroperitoneal splenosis mimics metastatic right adrenal mass.

Presentation Of Case: A 28-year-old man who had previously undergone post traumatic splenectomy at childhood and subsequently presented with an large incidental non-functioning right adrenal mass with presence of extra-hepatic peritoneal focal lesion diagnosed as metastasis by magnetic resonance imaging (MRI). Adrenalectomy with metatstectomy was performed, and both masses were identified to be splenosis.

Discussion: Adrenal incidentalomas (AIs) is defined as asymptomatic masses >1 cm. on cross-sectional imaging studies. AIs have significant malignant potential for masses > 6 cm. Splenosis are found most frequently in the left retroperitoneum in cases involving retroperitoneal splenosis. However, right retroperitoneal splenosis have been reported. Traditional imaging techniques cannot differentiate splenosis from malignancy.

Conclusion: Large right adrenal incidentalomas present with other abdominal, peritoneal masses could be splenosis in patient following post-traumatic splenectomy.
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http://dx.doi.org/10.1016/j.ijscr.2018.05.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019759PMC
June 2018

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

Arab J Urol 2017 Sep 9;15(3):216-222. Epub 2017 May 9.

Department Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

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 or multicentricity at the time of diagnosis of UTUC, were significant predictors of intravesical tumour recurrence. Ureteric tumour was the only identified risk factor ( = 0.02). Post-treatment bladder recurrence was a significant predictor of later urethral recurrence ( = 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.
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http://dx.doi.org/10.1016/j.aju.2017.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651950PMC
September 2017

Validation of the Arabic version of the Functional Assessment of Cancer Therapy-Bladder questionnaire in Egyptian patients with bladder cancer.

Arab J Urol 2017 Jun 25;15(2):110-114. Epub 2017 Apr 25.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objectives: To validate the Arabic version of the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) questionnaire in Egyptian patients who underwent radical cystectomy (RC) and orthotopic neobladder (ONB) construction.

Patients Subjects And Methods: The English version of the FACT-Bl was translated into the Arabic language using multi-step process by two urologist and two independent translators. The Arabic version was validated by inviting 90 patients who underwent RC and ONB and 72 normal individuals to complete the questionnaire. The reliability of the questionnaire was tested for internal consistency using the Cronbach's test. Inter-domain association was tested by Spearman's correlation coefficient. The discrimination validity was measured by comparing the scores in RC patients and in normal individuals using the Mann-Whitney -test and independent sample -test.

Results: Internal consistency was high for all domains. There was high correlation between all domains. This high internal consistency and good correlation was maintained when assessment included patients with <7.5 and those with ≥7.5 years follow-up. Discrimination validation was confirmed by the statistically significant lower scores of all domains in the studied patients in comparison to the controls.

Conclusion: The Arabic version of the FACT-Bl is a reliable and validated instrument that can be used to evaluate health-related quality of life in patients after RC and ONB.
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http://dx.doi.org/10.1016/j.aju.2017.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653643PMC
June 2017

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

Urol Oncol 2017 12 24;35(12):671.e11-671.e16. Epub 2017 Aug 24.

Urology and Nephrology Center, Mansoura University, Egypt.

Purpose: To investigate the long-term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors.

Material And Methods: We retrospectively analyzed a prospectively evaluated cohort of women for whom RC and ONB were performed. Patients in CUR were evaluated for the cumulative incidence of CUR using Kaplan-Meier curve and for the possible risk factors using log rank and Cox regression analysis.

Results: A total of 234 women with mean age ± SD of 52.3 ± 9 years and a median (range) of follow-up of 92 (12-247) months were included. The incidence of CUR increased with time, where 12 (5.2%), 21 (8.97%), 35 (14.9%), 53 (22.6%), and 56 (24%) patients started clean intermittent catheterization in 1, 2, 2 to 5 years, 5 to 10 years, and after 10 years of follow-up, respectively. In univariate and multivariate analysis, diabetes mellitus and urethral Kock pouch were independent predictors of CUR development (HR [95% CI] = 2.45 [1.2-5.1], and 2.1 [1.05-4.2], P = 0.01 and 0.03, respectively). Genital- sparing RC and surgical modification to provide pouch back support were independent factors that reduce CUR development (HR [95% CI] = 9.3 [1.25-69.9], and 2.1 [1.19-3.9], P = 0.02 and 0.01, respectively).

Conclusion: The incidence of CUR after RC and ONB in women increases with time even after 10 years of follow-up. Presence of diabetes mellitus increases the risk of CUR development. Genital-sparing RC and modification to prevent CUR reduced the likelihood of CUR development.
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http://dx.doi.org/10.1016/j.urolonc.2017.07.032DOI Listing
December 2017

Contemporary Management of Renal Transplant Recipients With De Novo Urolithiasis: A Single Institution Experience and Review of the Literature.

Exp Clin Transplant 2017 Jun;15(3):277-281

From the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objectives: We report on the long-term follow-up of managing allograft stones at a single tertiary referral institution and review the relevant literature.

Materials And Methods: A retrospective analysis of renal allograft recipient charts was performed to identify patients who developed allograft lithiasis between 1974 and 2009. Patient and stone characteristics, diagnoses, treatments, and outcomes were described.

Results: Sixteen patients developed 22 stones after a median follow-up of 170 months (range, 51-351 mo). The mean (standard deviation) and median diameter of the stones were 13.8 (8.5) mm and 11 mm. Among these, 3 stones were treated conservatively, 3 by shock-wave lithotripsy, and 7 by cystolitholapaxy. Seven patients underwent percutaneous treatment in the form of percutaneous nephrostomy tube fixation and spontaneous passage of stone (1 stone), shock-wave lithotripsy (1 stone), antegrade stenting (1 stone), and percutaneous nephrolithotomy (6 stones). All patients were stone free after treatment, except for 2 patients whose stones were stable and peripheral on long-term follow-up.

Conclusions: Allograft lithiasis requires a multimodal treatment tailored according to stone and graft characteristics. Protocols regarding spontaneous passage can be adopted if there is no harm to the graft and the patient is compliant. Careful attention to the anatomy during percutaneous nephrostomy tube placement is mandatory to avoid intestinal loop injury. A more attentive follow-up is required for early stone management.
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June 2017

Hospital admission for treatment of complications after extracorporeal shock wave lithotripsy for renal stones: a study of risk factors.

Urolithiasis 2018 Jun 29;46(3):291-296. Epub 2017 May 29.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

The objective of this study was to determine risk factors of hospital admission for treatment of complications after extracorporeal shock wave lithotripsy (SWL). The electronic files and images of all patients who underwent SWL for treatment of renal stones between January 2011 and December 2015 were retrospectively reviewed. All patients underwent SWL with the same electromagnetic lithotripter (Dornier Lithotripot S). The data of those who needed hospital admission for treatment of complications within 30 days after SWL were compared with patients who did not require hospital admission. Compared data included patients' demographics (age, gender, BMI, ASA score, and pre-SWL stenting), renal characters (side, hydronephrosis, and solitary kidney), and stone characters (site, length, density, and previous treatment). Univariate and multivariate statistical analyses were used to identify risk factors. The study included 1179 patients. Complications that required hospital admission were observed in 108 patients (9.2%). They included obstructing steinstrasse in 91 (7.7%), peri-renal hematoma in 3 (0.25%), and fever (>38.0 °C) in 14 (1.2%). Independent risk factors on multivariate analysis were solitary kidney (OR 2.855, P = 0.017), pre-SWL stenting (RR 2.03, P = 0.044), ASA II (OR 1.965, P = 0.007), hydronephrosis (RR 1.639, P = 0.024), and stone length (RR 1.083, P < 0.001). Patients with medical co-morbidities, pre-SWL ureteral stents, large stones and those with obstructed and/or solitary renal unit are more liable to post-SWL complications that need hospital admission. The probability of hospital admission has to be explained to patients with these risk factors.
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http://dx.doi.org/10.1007/s00240-017-0983-0DOI Listing
June 2018

Idiopathic retroperitoneal fibrosis: clinical features and long-term renal function outcome.

Int Urol Nephrol 2017 Aug 13;49(8):1327-1334. Epub 2017 May 13.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Purpose: To evaluate the long-term renal function outcome of management of retroperitoneal fibrosis (RPF)-induced ureteral obstruction.

Methods: Thirty-six patients with idiopathic RPF-induced ureteral obstruction were classified according to the management type into two groups, group A; managed by indwelling JJ stent and group B managed by ureterolysis and omental wrapping (UOR). The primary outcome was to define the long-term outcome of management on RF. It was evaluated by changes in serum creatinine and estimated GFR (eGFR) using Modification of Diet in Renal Disease equation where 20% changes in eGFR is considered significant. The second outcome is to compare the outcomes between both groups.

Results: After 27.5 (1-124) months, median (range) follow-up, median (range) serum creatinine increased significantly from 1.5 (0.8-8.1) to 1.6 (1-12.1) mg/dl (p value =0.04) and eGFR showed non-statistical significant reduction from 43 (5-110) to 41 (5-88) ml/min/1.73 m (p value =0.3). Eight (22.2%), 12 (34.4%) and 16 (44.4%) patients showed stable, increased and decreased eGFR. Group A showed statistically significant increased serum creatinine and insignificant decreased eGFR (p value =0.04 and 0.09), while group B showed statistically insignificant changes in serum creatinine and eGFR (p value =0.5 and 0.9). In group B, nine (21.4%) renal units are still harboring JJ stents.

Conclusion: For idiopathic RPF, UOR avoided indwelling ureteral stents in 78.6% of renal units with apparent better long-term renal function outcome.
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http://dx.doi.org/10.1007/s11255-017-1608-9DOI Listing
August 2017

Acute kidney injury after percutaneous nephrolithotomy for stones in solitary kidneys.

Scand J Urol 2017 Apr 29;51(2):165-169. Epub 2017 Mar 29.

b Department of Anesthesia , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt.

Objectives: The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys.

Methods: The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2-5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI.

Results: The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively).

Conclusions: The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.
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http://dx.doi.org/10.1080/21681805.2017.1295103DOI Listing
April 2017

Health related quality of life after radical cystectomy in women: orthotopic neobladder versus ileal loop conduit and impact of incontinence.

Minerva Urol Nefrol 2017 Jun 29;69(3):262-270. Epub 2016 Sep 29.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Background: Enough data about health related quality of life (HRQOL) after radical cystectomy (RC) and urinary diversion (UD) in women is still lacking. The objectives are to evaluate HRQOL in women after RC and orthotopic neobladder (ONB) versus ileal loop conduit (IC) and to assess the impact of urinary continence.

Methods: The study included 145 women who underwent RC and came for routine follow-up. HRQOL was assessed by two questionnaires (EORTC-QLQ-C30and FACT-Bl). ONB group was stratified to: totally continent, with nocturnal incontinence (NI) and patients in chronic urinary retention (CUR) and maintained on CIC. The orthotopic group (as a whole and its 3 subgroups) was compared to IC.

Results: ONB group included 22 continent women, 35 with NI and 27 in CUR and on CIC. There were no statistically significant differences between ONB and IC groups in all domains of the two questionnaires. However, continent women showed statistically significant better most of EORTC-QLQ-C30 scales and emotional well-being, functional well-being, bladder cancer subscale and FACT-Bl total Score (P˂0.05) than IC group. Similarly, women in CUR showed statistically significant better global health and physical functioning EORTC-QLQ-C30 scores (P values=0.0001, 0.01) and all domains of FACT-Bl. On the other hand, women with NI showed statistically significant lower values in all domains of the EORTC-QLQ-C30 and FACT-Bl than IC group.

Conclusions: In women, HRQOL is better after ONB than IC as long as continence status is preserved. If incontinence is expected, IC may be a better option for UD.
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http://dx.doi.org/10.23736/S0393-2249.16.02742-9DOI Listing
June 2017

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

Urol Ann 2016 Jan-Mar;8(1):95-8

Department of Urology, Urology and Nephrology Center, Mansoura University, Egypt.

"Inflammatory pseudotumor" (IPT) has infrequently been reported in the medical journals. A retrospective analysis was conducted among more than 2,000 bladder tumor cases from January 1999 to December 2012 looking for patients with IPT in the final diagnosis. Six patients were found with median tumor size of 3.5 cm (range: 3-8 cm); computed tomography and/or magnetic resonance imaging was used to diagnose the tumor. All patients had complete resection of the tumors. On a median follow-up of 6 years (range: 2-10 years), no recurrences for IPT have been observed in all patients. We concluded that IPT is a rare disease of the urinary bladder and should be regarded with a high degree of suspicion. Although an extensive workup may be needed for definite diagnosis, it is worth to avoid unnecessary chemoradiotherapy or radical surgeries.
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http://dx.doi.org/10.4103/0974-7796.165731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719523PMC
February 2016

After urgent drainage of an obstructed kidney by internal ureteric stenting; is ureteroscopic stone extraction always needed?

Arab J Urol 2015 Dec 20;13(4):258-63. Epub 2015 Oct 20.

Urology and Nephrology Centre, Mansoura University, Egypt.

Objectives: To assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction.

Patients And Methods: Between January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients' demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses.

Results: Emergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P = 0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P < 0.001) were independent predictors of the need for ureteroscopic stone extraction at the time of stent removal.

Conclusion: Spontaneous ureteric stone passage is possible after emergent drainage of an obstructed kidney by ureteric stenting. Stone opacity, larger stone width, and positive preoperative urine culture are associated with a greater probability of requiring ureteroscopic stone extraction after emergent drainage by ureteric stenting.
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http://dx.doi.org/10.1016/j.aju.2015.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4656795PMC
December 2015

Sildenafil activates antioxidant and antiapoptotic genes and inhibits proinflammatory cytokine genes in a rat model of renal ischemia/reperfusion injury.

Int Urol Nephrol 2015 Nov 16;47(11):1907-15. Epub 2015 Sep 16.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Objectives: To study the possible renoprotective effect of sildenafil against renal ischemia/reperfusion (I/R) injury and its effect on the expression of some antioxidant, antiapoptotic gene and proinflammatory cytokine genes in rat model of renal I/R injury.

Materials And Methods: One hundred and twenty male Sprague Dawley rats were subdivided into three equal groups: sham (underwent right nephrectomy without ischemia), control (underwent right nephrectomy and left ischemia for 45 min) and study [as control with 1 mg/kg sildenafil (per oral) 60 min before anesthesia]. Serum creatinine and BUN were measured at the baseline and the study endpoints (2, 24, 48 h and 7 days), and the left kidney was harvested at study endpoints for histopathological examination as well as for assessment of the expression of antioxidant genes (Nrf-2, HO-1 and NQO-1), antiapoptotic gene (Bcl-2) and inflammatory cytokines, e.g., TNF-a, IL-1β and ICAM-1.

Results: I/R caused significant increase in serum creatinine, BUN, histopathological damage score (p < 0.001) and significant reduction in antioxidant genes (nrf2, HO-1 and NQO-1) and antiapoptotic gene (Bcl2) with significant increase in TNF-a, IL-1β and ICAM-1 genes in kidney tissues. Pretreatment with sildenafil caused significant attenuation of serum creatinine and BUN as well as significant increase in the expression of antioxidant genes and Bcl-2 genes with significant reduction in the expression of proinflammatory cytokine genes (p value < 0.001).

Conclusion: The renoprotective effect of sildenafil against renal I/R might be due to the activation of antioxidant genes (Nrf2, HO-1 and NQO-1) and antiapoptotic gene (Bcl2) and attenuation of proinflammatory cytokines (TNF-a, IL-1β and ICAM-1).
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http://dx.doi.org/10.1007/s11255-015-1099-5DOI Listing
November 2015

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

Arab J Urol 2014 Jun 11;12(2):130-6. Epub 2013 Dec 11.

Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.

Objectives: To review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery.

Patients And Methods: We retrospectively reviewed all cases of testicular tumours managed at our institution between 1999 and 2009. Boys aged <16 years were included in the study. The patients' characteristics, presentation, the diagnostic tools, tumour markers, mode of treatment, pathological findings and outcome were assessed. We reviewed previous reports that addressed testicular and paratesticular tumours in prepubertal boys, using a Medline/PubMed search.

Results: From 80 patients, 13 boys (median age 8.7 years) presented with testicular tumours (16%) and were included in the study. Two boys presented with precocious puberty and one with gynaecomastia. The level of α-fetoprotein was high in three boys, and the human chorionic gonadotrophin level was elevated in one, and both markers were high in one. Testicular-sparing surgery was performed in three boys. Six of the 13 tumours were malignant and seven were benign. None of the patients developed a recurrence or testicular atrophy after testicular-sparing surgery. From the review of previous reports we devised an evidence-based algorithm for managing prepubertal testicular tumours.

Conclusions: Paediatric testicular tumours are rare but they require an inguinal approach for either orchidectomy or testicular-sparing surgery; we recommend the latter option as long as frozen sections are analysed and a safety margin is maintained.
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http://dx.doi.org/10.1016/j.aju.2013.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434582PMC
June 2014

Studying the Morbidity and Renal Function Outcome of Missed Internal Ureteral Stents: A Matched Pair Analysis.

J Endourol 2015 Sep 29;29(9):1070-5. Epub 2015 Apr 29.

Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt .

Purpose: To investigate the effect of missed internal ureteral stents (IUS) on renal function and to describe different modalities of management and associated morbidity.

Patients And Methods: A retrospective study included patients with missed IUS (>1 year). The complications of missed IUS were categorized according to the forgotten, encrusted, calcified (FECal) grading system. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation at time of initial stent placement and time of stent removal. An age- and sex-matched group of patients who had IUS and had available follow-up for the same duration of the study group were used as a control.

Results: A total of 46 missed IUS in 46 patients were included. Complicated stents were reported in 34 (73.9%) patients. FECal grade 1 was reported in 16 (57.2%) patients followed by grade 2 and 4 in 5 (17.8%) patients each. Retrograde removal, visual cystolitholapaxy, ureteroscopy with laser disintegration of encrustations and combined retrograde and antegrade approach have been used in 21, 5, 10, and 9 patients, respectively. In the missed IUS group, the mean±standard deviation (SD) eGFR has declined from 65.5±26.3 mL/min/1.73m(2) to 54.3±30 mL/min/1.73m(2) (P=0.001). While in the control group, the mean±SD eGFR has increased from 57.5±30 mL/min/1.73 m(2) to 66.7±27 mL/min/1.73 m(2) (P=0.001).

Conclusions: Missed IUS were associated with significant complications that necessitated more invasive intervention. In addition, IUS had a negative impact on renal function at time of removal.
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http://dx.doi.org/10.1089/end.2015.0047DOI Listing
September 2015

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

Authors:
Mohamed H Zahran

Int J Urol 2014 Sep 10;21(9):892-3. Epub 2014 Jun 10.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

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http://dx.doi.org/10.1111/iju.12505DOI Listing
September 2014

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

Int J Urol 2014 Oct 27;21(10):999-1004. Epub 2014 May 27.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

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

Methods: Between March 1976 and January 2011, 2208 recipients underwent live donor renal allotransplantation. A retrospective review of recipients with vascular accidents - renal artery thrombosis and renal vein thrombosis - was carried out. Salvage procedures were recorded and their outcomes were assessed.

Results: A total of 23 (1%) vascular accidents occurred, including renal artery thrombosis and renal vein thrombosis in 19 (0.8%) and four (0.18%) recipients, respectively. All renal artery thrombosis patients were treated by open revascularization and the graft was salvaged in 12 patients (63%). Two renal vein thrombosis events were resolved by percutaneous catheter-directed thrombolytic therapy. Of the other two allografts, one was salvaged by thrombectomy and revascularization, and the other was lost. On univariable analysis, older recipients (P = 0.003), pretransplant hypertension (P =  0.001), more human leukocyte antigen mismatches (≥3; P = 0.036), shorter ischemia time (≤45 min; P = 0.004) and longer time to diagnosis (>3.5 days; P = 0.013) were significantly associated with non-salvage of the graft after vascular accidents. Nevertheless, none of these variables were significant on the multivariable analysis. Over a median follow up of 35 months, the median (range) serum creatinine was 2 mg/dL (range 0.8-8.8 mg/dL), and 11 (79%) recipients were living with functioning grafts.

Conclusions: Despite the devastating complications, vascular accidents are salvageable and revascularization is crucial for graft salvage. Angiographic percutaneous techniques are viable alternatives for renal vein thrombosis.
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http://dx.doi.org/10.1111/iju.12485DOI Listing
October 2014
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