Publications by authors named "Osama Sarhan"

53 Publications

Pyeloplasty in children with low differential renal function: Functional recoverability.

J Pediatr Urol 2021 Jul 7. Epub 2021 Jul 7.

Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Introduction And Objective: Ureteropelvic junction obstruction (UPJO) is a common pathology in pediatric urology practice. Indications for intervention are well established while the ideal management of children with UPJO in poorly functioning kidneys is still debatable. We aimed in this study to evaluate the outcome of pyeloplasty in patients with UPJO and low DRF ≤20%.

Study Design: We retrospectively evaluated 218 children with congenital UPJO from two tertiary hospitals between 2008 and 2018. We included only those with primary unilateral UPJO and DRF ≤20% on diuretic renography. Open dismembered pyeloplasty with stenting was carried out in all. Patients with bilateral UPJO, solitary kidney, DRF above 20%, association with other urinary anomalies and patients who underwent previous renal or ureteric surgeries and patients with missed follow-up were excluded. Clinical and radiological outcomes of this subgroup of patients were assessed.

Results: A total of 21 patients (12 boys, 9 girls) with a median age at surgery of 2 years were included. Preoperative DRF ranged from 8 to 20% with a mean of 15% ± 3.5%. The median follow-up period was 2.5 years. Renal ultrasound showed improved HN in 16 patients (4 had a complete resolution) and stable in the remaining 5. Most of the improvement was noted in the first postoperative ultrasonography 16/21 (76%). Diuretic renography showed improved DRF by 10-15% in 8 patients (38%) while the remaining patients showed stable DRF with a non-obstructive curve with a mean improvement in DRF of 8 ± 5%. No postoperative complications were encountered and none of our patients required reintervention during follow-up.

Discussion: The ideal management of children with UPJO and poorly functioning kidneys is still arguable. In our study we evaluated the outcome of pyeloplasty in patients with a low DRF ≤ 20% aiming to test the patients' variables that can affect the improvement of DRF and HN grade after surgical intervention, however, none of these preoperative variables seemed to be a significant predictor.

Conclusions: Children with unilateral UPJO and DRF ≤ 20% have a favorable outcome after pyeloplasty. Improvement of HN in the first postoperative renal ultrasound is a good indicator for success.
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http://dx.doi.org/10.1016/j.jpurol.2021.07.003DOI Listing
July 2021

Laparoscopic nephrectomy in children: Does the approach matter?

Authors:
Osama M Sarhan

J Pediatr Urol 2021 May 13. Epub 2021 May 13.

Mansoura Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt. Electronic address:

Introduction And Objective: Laparoscopic nephrectomy (LN) is an established technique for the management of benign non-functioning kidneys in children. It can be performed either by the transperitoneal (TP) or retroperitoneal (RP) approach. The aim of this study was to compare safety and efficacy of TP with RP approach for LN in children.

Study Design: Between 2007 and 2019, 79 consecutive pediatric patients with benign non-functioning kidneys underwent laparoscopic nephrectomy by a single surgeon. Patients were categorized into two groups according to the approach; Group 1 included 41 patients who underwent transperitoneal laparoscopic nephrectomy (TPLN), while Group 2 included 38 patients who underwent retroperitoneal laparoscopic nephrectomy (RPLN). Comparison was done between the two groups regarding the mean operative time, complications, time to resume oral intake, need for postoperative analgesia and postoperative hospital stay.

Results: Laparoscopic nephrectomy was successfully completed in 75 of the 79 cases. Four cases were converted to open surgery: 3 from the TPLN group and one from the RPLN group (p = 0.34). There was statistically significant difference between the two groups in terms of estimated blood loss (p = 0.013), time to resume oral intake (p = 0.001) and postoperative hospital stay (p = 0.024). Overall, there was no statistically significant difference as regard mean operative time, overall complication rate, and postoperative analgesia need.

Discussion: LN is now an established technique in children and surgeon experience is a limiting factor. This experience should be gained progressively with respect to both TP and RP approaches to deal with different indications by optimal approach. Both TP and RP approaches are excellent approaches and it is up to individual surgeons, based on their experience, which approach they select. In this study, a comparative study was made between both TP and RP approaches for pediatric LN. There was no statistically significant difference between the two approaches as regard success rate, mean operative time, need for postoperative analgesia and overall complication rate. In the meantime, RPLN had the advantage of lower intraoperative blood loss, shorter time to resume oral intake and shorter hospital stay.

Conclusions: Laparoscopic nephrectomy in children may be performed by transperitoneal or retroperitoneal approaches, obtaining equal safety and efficacy. The retroperitoneal approach seems to be advantageous in terms of lower intraoperative blood loss, time to resume oral intake and shorter postoperative hospital stay.
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http://dx.doi.org/10.1016/j.jpurol.2021.05.006DOI Listing
May 2021

Comparison between internal double J and external pyeloureteral stents in open pediatric pyeloplasty: A multicenter study.

J Pediatr Urol 2021 Mar 30. Epub 2021 Mar 30.

Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Introduction And Objective: Anderson-Hynes dismembered pyeloplasty is considered the standard surgical treatment for ureteropelvic junction obstruction (UPJO). After pyeloplasty, stent drainage remains controversial. The commonly used stents are either an internal double-J (DJ) or an externalized pyeloureteral (PU) stents. We evaluated the outcome of using DJ versus PU stents following open pyeloplasty for UPJO in children.

Study Design: We retrospectively evaluated 175 patients who underwent primary open pyeloplasty in two tertiary hospitals. A total of 110 patients underwent internal DJ stent insertion (63%) while 65 patients (37%) underwent placement of external PU stent. The type of stent used at the time of surgery was according to surgeon preference and experience. Operative time, postoperative hospital stay, overall complications and success rates were compared between the two groups.

Results: The mean age was 3.8 years, and the mean follow-up was 4 years. Mean operative time was similar in the two groups (145 min). Mean hospital stay was 3.7 and 4.2 days in DJ and PU stent, respectively (p = 0.003) Summary Table . Postoperative complication developed in 9 out of 110 patients with DJ stent (8%), while complications developed in 6 out of 65 patients with PU stent (9%) (p = 0.81). Success rate of pyeloplasty was 95.5% for DJ group versus 97% for PU group (p = 0.63).

Discussion: Dismembered pyeloplasty remains the standard treatment of choice as a surgical management for UPJO. A debate is still there in respect to the method of PU anastomotic stenting and which stent can be used. The major advantage for external PU stents is that it can be removed safely in the outpatient clinic without any sedation preventing the risk of repeated exposure to general anesthesia. Internal DJ stent provides a shorter hospital stay and comparable complication and success rates compared with PU stent. If we manage to overcome the longer DJ stent duration and facilitate early removal by an easy mode, that does not require another anesthesia at that moment we can find the optimal stent for all pyeloplasty cases.

Conclusions: The two types of stents are comparable as regard overall complication and success rates after pyeloplasty. Although internal DJ stent insertion provides a relatively shorter hospital stay, a second operating room visit and anesthesia for removal remains unavoidable.
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http://dx.doi.org/10.1016/j.jpurol.2021.03.027DOI Listing
March 2021

Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective.

Cureus 2020 Dec 25;12(12):e12266. Epub 2020 Dec 25.

Urology, King Fahad Specialist Hospital, Dammam, SAU.

Objective Vesicoureteral reflux (VUR) is a common finding in the pediatric population with the risk of repeated infections and renal damage. There is little is known about the natural history of primary bilateral high-grade reflux. Herein we present our experience in the management of primary high-grade bilateral VUR and the long-term outcome of renal function in this specific group of patients. Materials and methods We retrospectively evaluated all patients with congenital bilateral VUR between 2006 and 2014. Records were reviewed for patient age at diagnosis, antenatal history, clinical presentation, the grade of VUR on voiding cystourethrogram (VCUG), presence of scars on dimercaptosuccinic acid (DMSA) scan, indications for surgical intervention, and surgical approaches. Clinical and radiological outcomes of this subgroup of patients were assessed. Results A total of 67 patients with bilateral VUR were identified, of whom 31 (20 boys and 11 girls) had primary high-grade (grade IV and V) bilateral VUR. The mean age at diagnosis was seven months. DMSA scans showed renal scars in 19 patients (61%) and eight of them were bilateral. Surgical intervention was necessary for 81% of patients with a success rate of 58% after endoscopic correction and 100% after reimplantation. Chronic kidney disease (CKD) developed in 13 patients (42%) after a mean follow-up of eight years. Conclusions Primary bilateral high-grade VUR carries a high rate of surgical intervention. The endoscopic correction has an acceptable success rate and efficient long-term outcome. Nevertheless, a significant proportion of patients progresses to CKD even after VUR management.
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http://dx.doi.org/10.7759/cureus.12266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834586PMC
December 2020

Unusual Presentation, Relapse, and Metastasis of a Pediatric Testicular Yolk Sac Tumor: Case Report.

Urology 2021 Mar 24;149:e40-e43. Epub 2020 Oct 24.

Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Testicular tumors are not uncommon in children and represent 1%-2% of all pediatric malignancies. Prepubertal testicular yolk sac tumor is the most common childhood testicular cancer, accounting for 70%-80% of all cases. The clinical presentation varies from one patient to another; most common presentation is painless scrotal mass. Herein, we present a case of pediatric patient with a testicular yolk sac tumor who had unusual presentation followed by a local relapse and metastasis and continued to have high markers while he was on chemotherapy, then underwent retroperitoneal lymph node dissection and local recurrence excision.
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http://dx.doi.org/10.1016/j.urology.2020.10.014DOI Listing
March 2021

Extract Attenuates Methotrexate-Induced Testicular Injury in Rats: Cross-talk Between Oxidative Stress, Inflammation, Apoptosis, and miRNA-29a Expression.

Integr Cancer Ther 2020 Jan-Dec;19:1534735420969814

Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

leaf extract (GIN) is a popular Chinese herbal medicine. It has a nephroprotective effect against the nephrotoxicity induced by the chemotherapeutic agent methotrexate (MTX). This work was designed to explore the testicular protective role of GIN on MTX-induced testicular injury in a rat model. The experimental protocol lasted for 10 days for the 4 studied groups. First group: received saline (normal control, NC group). The second group was administered GIN (100 mg/kg/day) orally for 10 days (GIN C). Third group: injected with MTX (20 mg/kg ip) only on the fifth day (MTX group). Fourth group: administered GIN for 10 days with MTX injection on the fifth day (GIN+MTX group). MTX induced testicular injury as evident by a marked rise in the malondialdehyde (MDA) content, interleukin-6 (IL-6) and IL-1β protein levels, nuclear factor kappa-B (NF-κB) protein expression, bcl-2 associated × protein (Bax) mRNA expression, p53 mRNA and protein expressions, and miRNA29-a expression along with a marked decline in the serum level of testosterone and superoxide dismutase (SOD) content in testicular tissue in relation to the NC group. Moreover, histopathological testicular damage with a notable decrease in the Johnsen score together with a significant elevation in the testicular injury score was observed in the MTX group in comparison to the NC group. The administration of GIN ameliorated the biochemical changes as well as the testicular histopathological findings and scores. GIN could protect against MTX-induced gonadotoxicity by its antioxidant, anti-inflammatory, antiapoptotic activities plus the regulation of the miRNA-29a testicular expression.
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http://dx.doi.org/10.1177/1534735420969814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605049PMC
August 2021

Crossed fused renal ectopia: Diagnosis and prognosis as a single-center experience.

J Pediatr Surg 2021 Sep 8;56(9):1632-1637. Epub 2020 Sep 8.

Pediatric Urology Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Background: Crossed fused renal ectopia (CFRE) is a rare congenital malformation. Renal bladder ultrasound (RBUS) is a good tool for establishing the diagnosis, however, additional imaging with a voiding cystourethrogram (VCUG) and dimercaptosuccinic acid scan (DMSA) might be required. We assessed the need for postnatal evaluation and the long-term consequences in patients with this diagnosis.

Methods: A retrospective review of the records of all patients diagnosed with CFRE between 2004 and 2014 was done. We included all patients who underwent postnatal evaluation with RBUS, DMSA and VCUG. Long-term radiological and functional outcomes were assessed.

Results: A total of 29 patients with CFRE were identified. Majority of cases were detected antenatally (79%) and left to right crossed ectopia constituted the majority of cases (65%). RBUS revealed associated hydronephrosis (HN) in 11 patients (38%). DMSA scans confirmed the diagnosis in all patients and showed impaired renal function in 10 ectopic kidneys (34%). Vesicoureteral reflux was detected in 12 patients (41%); one third of them needed surgical intervention. Extra-urinary anomalies were present in 14 patients (48%) mainly of cardiac origin. After a mean follow-up of 4.5 years, 4 patients (14%) with extra-urinary anomalies developed chronic kidney disease and two of them died.

Conclusions: Crossed fused renal ectopia is commonly associated with both urinary and extraurinary malformations. Postnatal RBUS is usually sufficient for diagnosis, however, additional imaging may aid for confirming the diagnosis and detection of associated urinary anomalies. Presence of extra-urinary malformations with crossed fused ectopia carries a higher risk of morbidity.

Type Of The Study: Retrospective study [diagnostic/prognostic study].

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.08.030DOI Listing
September 2021

Impact Effect of Methyl Tertiary-Butyl Ether "Twelve Months Vapor Inhalation Study in Rats".

Biology (Basel) 2019 Dec 20;9(1). Epub 2019 Dec 20.

Entomology Department, Cairo University, Giza 12613, Egypt.

We investigated the early risk of developing cancer by inhalation of low doses (60 µL/day) of methyl tertiary butyl ether (MTBE) vapors using protein SDS-PAGE and LC-MS/MS analysis of rat sera. Furthermore, histological alterations were assessed in the trachea and lungs of 60 adult male Wistar rats. SDS-PAGE of blood sera showed three protein bands corresponding to 29, 28, and 21 kDa. Mass spectroscopy was used to identify these three bands. The upper and middle protein bands showed homology to carbonic anhydrase 2 (CA II), whereas the lower protein band showed homology with peroxiredoxin 2. We found that exposure to MTBE resulted in histopathological alterations in the trachea and the lungs. The histological anomalies of trachea and lung showed that the lumen of trachea, bronchi, and air alveoli packed with free and necrotic epithelial cells (epithelialization). The tracheal lamina propria of lung demonstrated aggregation of lymphoid cells, lymphoid hyperplasia, hemorrhage, adenomas, fibroid degeneration, steatosis, foam cells, severe inflammatory cells with monocytic infiltration, edema, hemorrhage. Occluded, congested, and hypertrophied lung arteries in addition, degenerated thyroid follicles, were observed. The hyaline cartilage displayed degeneration, deformation, and abnormal protrusion. In conclusion, our results suggest that inhalation of very low concentrations of the gasoline additive MTBE could induce an increase in protein levels and resulted in histopathological alterations of the trachea and the lungs.
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http://dx.doi.org/10.3390/biology9010002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168921PMC
December 2019

An isolated congenital absence of nasal columella: A case report and review of literature.

Int J Surg Case Rep 2019 22;58:167-169. Epub 2019 Apr 22.

Jordan University Hospital, Department of General Surgery, Jordan. Electronic address:

Introduction: The nasal columella is an important aesthetic and functional entity of the midface. Congenital absence of the nasal columella as an isolated anomaly is extremely rare.

Presentation Of Case: We present a case of total congenital aplasia of the nasal columella in a 3-month-old female infant. The deformity was not associated with any other anomalies and with no obvious underlying cause.

Discussion: Isolated congenital absence of the nasal columella is an extremely rare anomaly and its etiology is still unknown. Surgical reconstruction of absent nasal columella is challenging as a result of its complex anatomy, and different surgical techniques have been described in the literature to reconstruct the nasal columella with varying advantages and disadvantages.

Conclusion: The variety in available surgical techniques for the reconstruction of nasal columella necessitates a thorough preoperative evaluation in order to choose the most suitable surgical technique and achieve the best outcome, both functionally and esthetically.
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http://dx.doi.org/10.1016/j.ijscr.2019.04.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495086PMC
April 2019

Candesartan in a rat model of testicular toxicity: New insight on its protective mechanism.

Exp Biol Med (Maywood) 2019 05 1;244(7):593-601. Epub 2019 May 1.

2 Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.

Impact Statement: Cisplatin is a commonly used drug in the treatment of solid tumors and its application is associated with testicular toxicity. The effect of candesartan in cisplatin-induced testicular toxicity and its fundamental mechanism of action were investigated. Candesartan had certainly repaired the testicular injury and ameliorated both biochemical and histopathological changes. Candesartan mitigated the gonadotoxicity induced by cisplatin via antioxidative, anti-inflammatory, and antiapoptotic actions.
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http://dx.doi.org/10.1177/1535370219842149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545698PMC
May 2019

Different managements of horseshoe kidney stones, any difference in the outcome?

Urol Ann 2018 Jul-Sep;10(3):287-290

Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Purpose: The aim is to assess the outcomes of different approaches for the management of renal stones associated with horseshoe kidneys (HSKs) in our institution over a 12-year period.

Methods: A retrospective review of 144 patients with HSKs who presented from 2000 to 2012 was performed. Twenty-eight patients (19.4%) were found to have renal stones. Demographic data were collected; the method of treatment and the outcomes of stone management were reviewed. We excluded patients with non-functioning moieties and associated genitourinary anomalies, and those with incomplete data.

Results: We included 25 patients, of which 16 males (64%) and 9 females (36%), with a mean age of 37 years. Mean serum creatinine level was 66 mmol/L. Eleven patients with a stone size <8 mm were treated expectantly with medical treatment, with only one patient requiring endoscopic intervention. Six patients (24%) with a stone size between 1 cm and ≤2 cm were treated with extracorporeal shock wave lithotripsy (ESWL) with the placement of double J stents, and seven patients (28%) with a stone size of >2 cm were treated with percutaneous nephrolithotomy. One patient with a 10 mm stone was treated using flexible ureteroscopy. No significant perioperative complications were encountered.

Conclusions: Indications, methods of treatment, and outcomes of management of stones associated with HSKs were comparable to those for stones associated with normal kidneys. Tailored approach based on stone size is highly recommended. ESWL accompanied with ureteric stenting is a promising strategy for the management of stones associated with HSKs in selected patients requiring intervention.
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http://dx.doi.org/10.4103/UA.UA_116_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060601PMC
August 2018

The role of mesenchymal stem cells in chemotherapy-induced gonadotoxicity.

Stem Cell Res Ther 2018 07 18;9(1):196. Epub 2018 Jul 18.

Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.

Background: The therapeutic potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) against cisplatin-induced nephrotoxicity has been reported, however, its efficacy in gonadotoxicity still has not been addressed. Herein, we investigated the effect of BM-MSCs in cisplatin-induced testicular toxicity and its underlying mechanism of action.

Methods: Thirty male Sprague-Dawley rats were divided into a control group: injected with phosphate-buffered saline (PBS) intraperitoneal (ip), a cisplatin group: injected with a single dose of 7 mg/kg cisplatin ip to induce gonadotoxicity and a BM-MSCs group: received cisplatin ip followed by BM-MSCs injection 1 day after cisplatin. In testicular tissues, malondialdehyde (MDA), superoxide dismutase (SOD), and reduced glutathione (GSH) levels were assessed. Additionally, gene expressions of inducible nitric oxide synthase (iNOS), caspase-3, and p38 mitogen-activated protein kinase (MAPK) were measured. The testicular tumor necrosis factor alpha (TNF-α) protein contents and Bcl-2 associated X protein (BAX) expression were determined. Histopathology of testicular tissues was examined.

Results: Cisplatin injection showed a significant decrease in GSH and SOD testicular levels besides a significant increase of MDA and TNF-α testicular levels and upregulation of testicular gene expressions of iNOS, caspase-3, and p38-MAPK in comparison to the control group. Moreover, a marked increase in BAX protein expression was observed in the cisplatin group when compared with the control one. Histopathological examination exhibited significant seminiferous tubules atrophy in cisplatin-treated rats.

Conclusions: The BM-MSCs injection significantly repaired the testicular injury and improved both biochemical and histopathological changes. The MSCs mitigated the gonadotoxicity induced by cisplatin through antioxidative, anti-inflammatory, and antiapoptotic mechanisms.
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http://dx.doi.org/10.1186/s13287-018-0946-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052634PMC
July 2018

Isolated low grade prenatally detected unilateral hydronephrosis: do we need long term follow-up?

Int Braz J Urol 2018 Jul-Aug;44(4):812-818

Division Urology Pediatric, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Purpose: To assess the need for postnatal evaluation and the medium term outcome in patients with isolated unilateral low grade prenatally detected hydronephrosis.

Materials And Methods: We prospectively selected 424 patients (690 kidney units) with a prenatal diagnosis of urinary tract dilatation between 2010 and 2013. We included only those patients with isolated unilateral low-grade hydronephrosis who underwent at least 2 postnatal ultrasound examinations. The Society for Fetal Urology (SFU) grading system was utilized for assessment of the hydronephrosis. We excluded patients with bilateral dilation or other urological abnormalities. The fate of hydronephrosis including resolution, stability or worsening was documented.

Results: A total of 66 infants (44 boys and 22 girls) with antenatally diagnosed unilateral urinary tract dilation (23 right and 43 left) were identified. Ultrasounds showed SFU grade 1 hydronephrosis in 32 patients (48%) and SFU grade 2 hydronephrosis in 34 (52%). After a mean follow-up period of 32 months (range 12 to 60), 37 patients (56%) had complete resolution of hydronephrosis while the remaining 29 were stable (44%). None of our patients developed UTIs during follow-up and none required surgical intervention.

Conclusions: Prenatally detected, isolated unilateral low-grade hydronephrosis usually have a favorable prognosis. All cases in our cohort showed either stability or resolution of hydronephrosis without any harmful consequences. Based on our findings on medium-term in this category of patients, long-term follow-up is not warranted.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2017.0474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092662PMC
July 2018

Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?

Can Urol Assoc J 2018 Mar 22;12(3):E137-E141. Epub 2017 Dec 22.

Pediatric Urology Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

Introduction: Fetal hydronephrosis (HN) occurs in approximately 5% of pregnancies and its prognosis depends mainly on the grade of the dilation. We attempted to determine the fate of isolated, unilateral, high-grade HN in children with antenatal diagnosis, emphasizing the risk factors for progression.

Methods: We retrospectively evaluated 424 children (690 kidney units) with antenatal HN in the period between 2010 and 2014. We included only those patients with isolated high-grade HN (Society for Fetal Urology [SFU] Grade 3 or 4). Patients with bilateral HN or unilateral HN associated with dilated ureter or reflux and patients with missed followup were excluded. The prognosis of HN (whether improved, stabilized, or progressed) and the need for surgical intervention in this subset of patients was evaluated.

Results: A total of 44 children (34 boys and 10 girls) were identified. Ultrasounds showed SFU Grade 3 HN in 24 (54%) and SFU Grade 4 HN in 20 (46%). After a mean followup of three years (range 1-5), 10 children (23%) needed surgical intervention; four Grade 3 HN (16%) and six Grade 4 HN (30%). The majority of children with differential renal function (DRF) ≥40% (69.5%) were stable or improved. Five girls (50%) and five boys (17%) progressed and required surgical intervention. No patient with a renal pelvis anteroposterior diameter (APD) <1.5 cm needed surgical intervention.

Conclusions: Infants with isolated, unilateral, high-grade HN might be managed conservatively. Male gender, DRF ≥40%, SFU Grade 3 HN, and APD <1.5 cm were favourable prognostic factors.
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http://dx.doi.org/10.5489/cuaj.4587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869039PMC
March 2018

Posterior urethral valves: Impact of low birth weight and preterm delivery on the final renal outcome.

Authors:
Osama M Sarhan

Arab J Urol 2017 Jun 7;15(2):159-165. Epub 2017 Mar 7.

Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Objective: To investigate the relationship between low birth weight (LBW; <2.5 kg) and preterm delivery (<37 weeks gestational age) and final renal outcome in infants with posterior urethral valves (PUVs), emphasising the risk factors for the development of chronic kidney disease (CKD).

Patients And Methods: A retrospective review was performed for all infants with PUVs who were treated between 1990 and 2010. In all, 52 infants were identified to have LBW and/or delivered preterm (Group 1). Infants in Group 1 were compared with a matching group (Group 2) of 60 full-term normal birth weight (NBW) infants with PUVs managed during the same period. The outcome of both groups was analysed.

Results: During follow-up, CKD developed in 17 (32.5%) and 22 patients (36.5%) in Groups 1 and 2, respectively ( = 0.812). Patients with LBW or delivered preterm had significantly higher incidence of oligohydramnios ( = 0.009), increased risk of vesicostomy ( < 0.001), longer hospital stay ( < 0.001), and higher incidence of vesico-ureteric reflux (VUR,  = 0.024). In the LBW patients, initial serum creatinine, nadir serum creatinine, oligohydramnios and Neonatal Intensive Care Unit (NICU) length of stay were significant predictors of final renal outcome ( < 0.001,  = 0.002,  = 0.004 and  = 0.012, respectively).

Conclusion: In our cohort of LBW and preterm delivery infants with PUVs, outcomes were similar to those of NBW full-term infants with PUVs but with an increased risk of vesicostomy, longer hospital stay, and higher incidence of VUR. LBW was associated with oligohydramnios, longer NICU admission, high initial and nadir serum creatinine, which were associated with a poor prognosis.
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http://dx.doi.org/10.1016/j.aju.2017.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653607PMC
June 2017

Microbiological, histological, and biochemical evidence for the adverse effects of food azo dyes on rats.

J Food Drug Anal 2017 Jul 15;25(3):667-680. Epub 2017 Feb 15.

Department of Biology, Faculty of Applied Science, Umm Al-Qura University, Saudi Arabia; Department of Chemistry, Faculty of Science, Cairo University, Cairo, Egypt.

In this study, 120 lactic acid bacterial strains from different fermented dairy products as well as 10 bacterial intestinal isolates were evaluated for in vitro and in vivo degradation of various food azo dyes. Of these isolates, lactic acid bacteria (LAB) strains 13 and 100 and the intestinal isolates Ent2 and Eco5 exhibited 96-98% degradation of the tested food azo dyes within 5-6 hours. High performance liquid chromatography mass spectra of sunset yellow (E110) and carmoisine (E122) anaerobic degradation products by the intestinal isolates showed that they were structurally related to toxic aromatic amines. For an in vivo study, eight groups of rats were treated for 90 days with either the food azo dyes or their degradation products. All groups were kept for a further 30 days as recovery period and then dissected at 120 days. Hematological, histopathological, and protein markers were assessed. Rats treated with either E110/E122 or their degradation products exhibited highly significant changes in red blood cell count, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and white blood cell count. In addition, alanine and aspartate aminotransferases, amylase, total bilirubin, blood urea nitrogen, creatinine, glucose, total protein, and globulins were significantly increased. Furthermore, marked histopathological alterations in the liver, kidney, spleen, and small intestine were observed. Significant decreases in inflammation and a noticeable improvement in the liver, kidney, spleen, and small intestine of rats treated with LAB and food azo dyes simultaneously were observed. Finally, these results provide a reliable basis for not only a better understanding of the histological and biochemical effects of food additives, but also for early diagnostics. In addition, LAB strains 13 and 100 may play an important role as potential probiotics in food and dairy technology as a probiotic lactic acid starter.
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http://dx.doi.org/10.1016/j.jfda.2017.01.005DOI Listing
July 2017

Unilateral Renal Agenesis: Necessity of Postnatal Evaluation in a Contemporary Series.

Urology 2016 Dec 12;98:144-148. Epub 2016 Jul 12.

Pediatric Urology Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Objective: To assess the need for postnatal evaluation and the long-term consequences in patients with prenatal diagnosis of unilateral renal agenesis (URA).

Materials And Methods: A retrospective review of the records of all patients with prenatal diagnosis of URA between 2004 and 2013 was done. We included all patients who underwent postnatal evaluation with renal bladder ultrasound (RBUS), dimercaptosuccinic acid scan, and a voiding cystourethrogram. Long-term follow-up included physical examination and assessment of contralateral renal growth.

Results: A total of 46 children (24 boys and 22 girls) with URA were identified. Ultrasounds showed associated hydronephrosis in 9 patients (19%). Dimercaptosuccinic acid scans confirmed the diagnosis of URA in all patients and showed renal scars in 2 solitary kidneys (4%). Vesicoureteral reflux was diagnosed in 4 patients (12%); all were of low grade and managed conservatively. After a mean follow up of 4 years, RBUS showed compensatory hypertrophy in 31 patients (67%), 3 patients (6%) developed chronic kidney disease, and 2 patients (4%) developed hypertension.

Conclusion: Prenatally detected cases of URA should be promptly evaluated. RBUS is found to be sufficient for diagnosis. However, additional imaging may be indicated for confirming the diagnosis and detection of other associated urinary anomalies. Serial assessment of the contralateral solitary kidney growth and serum creatinine measurement will be helpful to assess kidney function on the long term.
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http://dx.doi.org/10.1016/j.urology.2016.07.002DOI Listing
December 2016

Uroprotective effect of oleuropein in a rat model of hemorrhagic cystitis.

Int J Biochem Cell Biol 2016 May 22;74:12-7. Epub 2016 Feb 22.

Urology Department, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia; Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.

Hemorrhagic cystitis is one of the devastating complications seen after receiving cyclophosphamide chemotherapy. Oleuropein is the most important phenolic compound of olive leaves that mediates most of its beneficial pharmacological properties. Herein, we investigated the possible uroprotective effect of oleuropein against cyclophosphamide induced hemorrhagic cystitis in a rat model. For this purpose, we measured bladder nitric oxide, reduced glutathione, catalase, tumor necrosis factor-alpha and vascular endothelial growth factor levels in addition to the bladder gene expression of intercellular adhesion molecule-1 after induction of hemorrhagic cystitis in the presence or absence of oleuropein. Histopathological examination of bladder tissues was also performed. After cyclophosphamide injection, we demonstrated a significant decrease in bladder reduced glutathione (39%) and catalase (55.4%) levels and a significant increase of nitric oxide (5.6 folds), tumor necrosis factor-alpha (3.3 folds), vascular endothelial growth factor (2 folds) and intercellular adhesion molecule-1 (8 folds) bladder contents when compared to those in normal control rats. Administration of oleuropein induced a marked elevation in bladder reduced glutathione (37.8%), catalase (100.4%) with a prominent reduction of bladder nitric oxide (40%), tumor necrosis factor-alpha (35.9%) and vascular endothelial growth factor (56.2%) levels along with downregulation of intercellular adhesion molecule-1 bladder expression (73.1%) in comparison to cyclophosphamide treated rats levels. Our data demonstrated that oleuropein counteracts the harmful effects of cyclophosphamide on the bladder through its antioxidant and anti-inflammatory activities. Oleuropein exerts a definite uroprotective effect against cyclophosphamide induced hemorrhagic cystitis in rats.
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http://dx.doi.org/10.1016/j.biocel.2016.02.012DOI Listing
May 2016

Fibroepithelial vaginal polyp in a newborn.

Urol Ann 2015 Apr-Jun;7(2):277-8

Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

A fibroepithelial polyp of the vagina (FEPV) is a mucosal polypoid lesion with a connective tissue core covered by a benign squamous epithelium. A vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls. This article describes a newborn girl with an interlabial mass that the histological analysis revealed to be an FEPV. Surgical excision of the mass was performed, and the patient has not experienced recurrence after 1-year of follow-up. A review of the literature revealed that our case was the third reported case of a fibroepithelial polyp in a neonate.
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http://dx.doi.org/10.4103/0974-7796.152952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374277PMC
April 2015

Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients.

Can Urol Assoc J 2014 Nov;8(11-12):E906-9

Mansoura Urology and Nephrology Center, Mansoura, Egypt.

Introduction: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children.

Methods: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay.

Results: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2-15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study's limitations include its retrospective design and relatively small sample size.

Conclusions: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures.
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http://dx.doi.org/10.5489/cuaj.1994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277531PMC
November 2014

Cisplatin-induced testicular toxicity in rats: the protective effect of arjunolic acid.

J Biochem Mol Toxicol 2014 Nov 6;28(11):515-21. Epub 2014 Aug 6.

Department of Biochemistry, Mansoura University, Mansoura, Egypt.

In the present study, the effect of arjunolic acid on testicular damage induced by intraperitoneal injection of rats with 7 mg/kg cisplatin was studied. Cisplatin induced a significant reduction in testicular weights, plasma testosterone, and testicular reduced glutathione levels in addition to a significant elevation of testicular malondialdehyde levels and testicular gene expressions of inducible nitric oxide synthase (iNOS), tumor necrosis factor-α (TNF-α), and p38 mitogen-activated protein kinase (MAPK) when compared with the control group (p < 0.05). Lower tubular diameters and depletion of germ cells and irregular small seminiferous tubules with Sertoli cells only were observed in the cisplatin group. Arjunolic acid administration significantly corrected the changes in both biochemical and histopathological parameters. Arjunolic acid plays a significant protective role against cisplatin-induced testicular injury by attenuating oxidative stress parameters along with downregulation of iNOS, TNF-α, and p38-MAPK testicular expressions.
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http://dx.doi.org/10.1002/jbt.21593DOI Listing
November 2014

Effects of intraperitoneally injected silver nanoparticles on histological structures and blood parameters in the albino rat.

Int J Nanomedicine 2014 24;9:1505-17. Epub 2014 Mar 24.

Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt.

Background: The purpose of this study was to investigate the effect of acute dosing with silver nanoparticles (AgNPs) and identify potential ultrastructural alterations in the liver and kidney and their effect on blood parameters in the albino rat.

Methods: Twenty rats were used to assess the acute effects of AgNPs. Rats in the treatment group were injected intraperitoneally with 0.5 mL of distilled water containing AgNPs at a dose of 2,000 mg/kg body weight followed by a second injection after 48 hours. Control rats received two 0.5 mL doses of distilled water only. After 3 days, blood samples were collected, and the rat kidneys and livers were extracted and processed for electron microscopy to investigate for hematologic and histopathologic alterations.

Results: Renal tubules showed swollen epithelium with cytoplasmic vacuolization, thickening of the basement membrane, and destruction of some mitochondrial cristae. Podocytes showed elongation and swelling of their primary and secondary processes. The basement membrane of the capillary tufts became thicker. The hepatic tissue showed narrowing of the sinusoids, swollen hepatocytes with hypertrophied nucleoli, and accumulation of fat globules in the nucleoplasm and cytoplasm. The hepatic sinusoids showed hypertrophied endothelial and Kupffer. Destructed cristae of some mitochondria, endosomes, and larger lysosomes filled with Ag-NPs were also observed in the Kupffer cells. Significant increases were observed in white blood cell count, lymphocyte count, granulocytes, and hemoglobin. There was a significant increase in serum creatinine, urea, and aspartate and alanine aminotransferases.

Conclusion: To the best of the authors' knowledge, the ultrastructural changes in renal and liver tissue observed in this study have not been described before. Our results suggest that injection of AgNPs could have severe cytotoxic effects on the structure and function of these organs.
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http://dx.doi.org/10.2147/IJN.S56729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969345PMC
August 2014

Perineal anastomotic urethroplasty in a pediatric cohort with posterior urethral strictures: critical analysis of outcomes in a contemporary series.

Urology 2014 May 31;83(5):1145-8. Epub 2014 Jan 31.

Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Objective: To evaluate the long-term outcomes of perineal anastomotic urethroplasty for post-traumatic pediatric posterior urethral strictures.

Methods: We retrospectively reviewed the medical records of 65 boys who had a perineal anastomotic urethroplasty for post-traumatic posterior urethral strictures between 1991 and 2010. Patients were followed up for a mean (range) of 78 (13-210) months by a history, urinary flow rate estimate, retrograde urethrography, and voiding cystourethrography. Regression analysis was done to assess the predictors of success after urethroplasty.

Results: The mean (range) age of the patients was 9.3 (3-16) years. The estimated radiographic stricture length before surgery was 2.4 (1-5) cm. All patients presented with a suprapubic cystostomy tube and scheduled for delayed or repeated correction of a urethral stricture. Twenty boys (30%) had failed previous attempts of repair elsewhere. Mean interval between the original trauma and repair in new cases, and since the last repair in recurrent cases, was 7 months. The perineal anastomotic repair was successful in 58 of 65 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in 5 patients and by repeat perineal anastomotic repair in the remaining 2. All boys are continent. There was no chordee or urethral diverticula during the follow-up.

Conclusion: One-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is feasible with minimal morbidity. Denovo cases and surgeon experience are the predictors of success after urethroplasty.
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http://dx.doi.org/10.1016/j.urology.2013.11.028DOI Listing
May 2014

Prune belly syndrome with urethral hypoplasia and vesico-cutaneous fistula: A case report and review of literature.

Urol Ann 2013 Oct;5(4):296-8

Department of Urology, Pediatric Urology Unit, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia.

Association between Prune belly syndrome (PBS) and urethral hypoplasia is an unusual condition. It is usually fatal unless there is a communication between the fetal bladder and the amniotic sac. We report a case of PBS with urethral hypoplasia and congenital vesico-cutaneous fistula in a male neonate. Patient underwent cutaneous vesicostomy and was discharged for close follow up of his renal function and for future reconstruction.
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http://dx.doi.org/10.4103/0974-7796.120299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835994PMC
October 2013

Did antenatal diagnosis protect against chronic kidney disease in patients with posterior urethral valves? A multicenter study.

Urology 2013 Dec 16;82(6):1405-9. Epub 2013 Oct 16.

Pediatric Department, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Pediatric Urology Unit, Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address:

Objective: To evaluate the prognostic role of antenatal diagnosis of posterior urethral valves (PUVs) on ultimate renal function.

Methods: Between 1990 and 2010, 315 patients with PUVs were diagnosed and treated at 2 separate tertiary centers. Primary valve ablation was performed in all patients except 18, who underwent initial vesicostomy. Patients were divided into two groups: group 1 included 144 patients who were diagnosed antenatally, and group 2 included 171 patients with a postnatal diagnosis. Long-term functional and radiologic outcomes were assessed.

Results: Follow-up was a median 5.5 years (range, 2-15 years). Mean age at ablation was 2.5 years (range, 1 day-15 years). Chronic kidney disease developed at the end of follow-up in 96 patients (30%): 27 (19%) in group 1 and 69 (40%) in group 2 (P <.05). The mean nadir serum creatinine was 0.6 and 0.8 mg/dL in groups 1 and 2, respectively, and the mean final serum creatinine was 0.9 and 1.7 mg/dL, respectively (P <.05). Persistent upper tract dilatation was noted in 43% of group 1 patients and in 69% of group 2 patients (P <.05).

Conclusion: The potential for recovering renal function is believed to be significant in patients in whom early detection of PUVs and, hence, early intervention was performed. Antenatal screening and detection of these patients might play a significant role in protecting the upper tract and reducing the incidence of chronic kidney disease.
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http://dx.doi.org/10.1016/j.urology.2013.07.058DOI Listing
December 2013

Changes in differential renal function after pyeloplasty in children.

J Urol 2013 Oct 9;190(4 Suppl):1468-73. Epub 2013 Jan 9.

Urology and Radiology (IS) Departments, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Purpose: Previous series showed controversial differential renal function outcomes after pyeloplasty in children. However, they were limited by study power, methodology and lack of comparable end points. We determined the status of differential renal function after pyeloplasty in children in what is to our knowledge the largest series to date.

Materials And Methods: After excluding patients with renal anomalies, solitary kidney or bilateral pyeloplasty from analysis, we retrospectively identified 196 younger than 18 years who were treated with pyeloplasty between May 2002 and January 2010 and had preoperative and postoperative renal scintigraphy available. Primary outcome measures were greater than 5% improvement in baseline differential renal function and baseline weighted differential renal function at last followup. Clinical variables predicting outcome measures were determined using univariable and multivariable analyses.

Results: During a median followup of 12 months, mean ± SD differential renal function improved from 35.8% ± 10% to 38.7% ± 11% (p <0.001). In the poor and intermediate groups baseline differential renal function improved, while in the good group function was static postoperatively (p <0.001). The linear regression model showed that only baseline differential renal function explained the variance in baseline weighted differential renal function (β = -0.393, p <0.001). In the Cox proportional hazards model baseline differential renal function (less than 35% HR 3.196, p <0.001 and 35% to 40% HR 2.733, p = 0.002) and cortical thickness (HR 2.114, p = 0.029) were the only predictors of a greater than 5% improvement in postoperative differential renal function.

Conclusions: Renal function improves after pyeloplasty in children. Baseline differential renal function and cortical thickness predict improvement after surgery.
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http://dx.doi.org/10.1016/j.juro.2013.01.004DOI Listing
October 2013

Critical analysis of outcome after open dismembered pyeloplasty in ectopic pelvic kidneys in a pediatric cohort.

Urology 2012 Dec 23;80(6):1357-60. Epub 2012 Oct 23.

Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Objective: To evaluate the functional and morphologic outcome after open pyeloplasty for ureteropelvic junction obstruction (UPJO) in ectopic pelvic kidneys.

Materials And Methods: A retrospective review of all patients who underwent open pyeloplasty in ectopic pelvic kidneys was conducted. Records were evaluated with respect to age at presentation, preoperative imaging, surgical details, and postoperative course. Patients were followed up regularly for functional and morphologic outcome. Success was defined as symptomatic relief and radiographic improvement of obstruction at the last follow-up.

Results: Between 1995 and 2010, 680 patients with primary UPJO underwent open dismembered pyeloplasty at our center. Of these patients, 43 (6.3%) had UPJO in ectopic pelvic kidneys. No perioperative complications were encountered in the study group. Mean follow-up was 42 months (range, 18-90 months), and 5 patients were lost to follow-up. The overall success rate was 82.6%. Postoperative hydronephrosis was improved in 20 (52.6%), stable in 11 (29%), and worsened in 7 (18.4%). Postoperative renal function was improved in 12 (31.6%), stable in 19 (50%), and deteriorated in 7 (18.4%). Redo pyeloplasty was required in 4 patients and secondary nephrectomy in 3. Preoperative differential renal function and surgeon experience were statistically significant predictors of improvement in renal function after pyeloplasty.

Conclusion: Open pyeloplasty for UPJO in ectopic pelvic kidneys is feasible, but varying degrees of hydronephrosis and radiologic obstruction persist after pyeloplasty that could be attributed to anatomy-related pelvocaliectasis, and so regular follow-up is warranted in this subpopulation.
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http://dx.doi.org/10.1016/j.urology.2012.07.057DOI Listing
December 2012

Bilateral Wilms' tumor: Mansoura multi-centers 15 years experience.

J Oncol Pharm Pract 2012 Mar 10;18(1):115-21. Epub 2012 Jan 10.

Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt.

Purpose: Bilateral Wilms' tumor (WT) is a challenge. Aggressive surgical resection is needed to prevent recurrence. We revised the clinico-epidemiological criteria of bilateral WT patients in our locality and relation to outcome.

Subjects And Methods: 462 WT patients were registered in three medical centers at Mansoura, Egypt. Twenty five patients had bilateral WT whose medical records were revised for all clinico-epidemiologic data plus treatment details, toxicity, and outcome.

Results: The mean age was 34.5 months; 64% of cases were female. Abdominal mass was the commonest presentation (72%). Congenital anomalies were reported in two cases (one case showed hemihypertrophy and the other showed aniridia). About 60% had favorable pathology. Nineteen cases had synchronous bilateral WT (76%) and the remaining (six cases) had metachronous tumors. For the synchronous cases, the response rate to preoperative chemotherapy was 79% and nephron sparing surgery for the least involved kidney was possible in all. Survival rate was 74%. Metachronous tumor management included nephrectomy followed by chemotherapy for the initially diagnosed tumors. However, nephron sparing surgery of the contralateral tumors following preoperative chemotherapy was possible in two cases and the survival rate was 33%. No renal failure or any therapy-related complications were reported.

Conclusions: Bilateral WT is predominantly synchronous with favorable histology, with female predilection and possibly congenital anomalies. Preoperative chemotherapy followed by nephron sparing surgery has a favorable outcome with preserved renal function especially in patients with synchronous WT. Response to preoperative chemotherapy had a statistically significant prognostic impact.
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http://dx.doi.org/10.1177/1078155210396575DOI Listing
March 2012

Doxazosin versus tizanidine for treatment of dysfunctional voiding in children: a prospective randomized open-labeled trial.

Urology 2012 Feb 22;79(2):428-33. Epub 2011 Dec 22.

Voiding Dysfunction and Urodynamic Section, Urology and Nephrology Center, Mansoura University, and Children's Hospital, Mansoura, Egypt.

Objective: To examine the efficacy and tolerability of tizanidine for the treatment of dysfunctional voiding in children compared with those of doxazosin.

Methods: A total of 40 children with dysfunctional voiding were enrolled in a prospective, randomized, 2-parallel group, flexible-dose study. The evaluations were performed in accordance with the International Children's Continence Society guidelines. The children were followed up after 1 week and then monthly for 6 months for the clinical, urine culture, and urodynamic parameters. The degree of improvement was assessed using a satisfaction scale that ranged from 0 (no improvement at all) to 10 (total improvement).

Results: A total of 40 patients with a mean±SD age of 7±2.6 years were enrolled. The clinical and urodynamic parameters were comparable between both groups. At the last follow-up visit, both groups had had similar improvement in the severity of symptoms, satisfaction scale, and noninvasive flowmetry parameters. In the doxazosin group, urge episodes was the only symptom that showed a significant reduction compared with the baseline values (P=.028). However, the incidence of nocturnal enuresis, urgency attacks, and daytime incontinence were significantly reduced compared with baseline in the tizanidine group (P=.003, P=.008, and P=.017, respectively). Adverse effects were recorded in 6 patients (15%). Epigasteric pain was reported in 2 children (10%) who received doxazosin. In the tizanidine group, a loss of appetite was noted in 2 children (10%), epigastric pain in 1 (5%), and headache in 1 (5%).

Conclusion: Tizanidine could be a safe and effective treatment of children with dysfunctional voiding due to pelvic floor/skeletal sphincter dysfunction. More placebo-controlled trails with larger sample sizes are needed.
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http://dx.doi.org/10.1016/j.urology.2011.10.043DOI Listing
February 2012

Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique.

Arab J Urol 2011 Sep 15;9(3):203-6. Epub 2011 Nov 15.

Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Objective: To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy.

Patients And Methods: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure.

Results: For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later.

Conclusions: Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.
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http://dx.doi.org/10.1016/j.aju.2011.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150575PMC
September 2011
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