Publications by authors named "Tarek Alzahrani"

8 Publications

  • Page 1 of 1

Giant hydronephrosis management in the Era of minimally invasive surgery: A case series.

Int J Surg Case Rep 2020 23;75:513-516. Epub 2020 Sep 23.

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

Introduction: Giant hydronephrosis (GH) is a rare urological entity, described as more than 1 L of fluid contained in the renal collecting system. Ureteropelvic junction obstruction (UPJO) is the most common cause. GH if not discovered and managed early can result in long term complications. We present our experience in the late presentation of adult Giant hydornephrosis.

Presentation Of Cases: We reviewed all the cases of patients with giant hydronephrosis who presented to our institute from December 2017-December 2019 at our institute. Pre-operative renal ultrasound, computed tomography with contrast and MAG-3 were performed on all patients to establish their diagnoses. The patients' demographic data, clinical presentation, preparatory investigations, indications for intervention, type of intervention, pre- and post-operative complications and durations of hospital stay were reported. Laparoscopic transperitoneal nephrectomy was completed in three cases without open conversion. One case proceeded to open conversion owing to a lack of space and severe adhesions. The mean operating time was 79.7 min (range: 65-95 min), estimated blood loss was 75 mL and the mean hospital stay was 4 days (range: 2-6 days).

Discussion: The first case of GH was described in 1746. Since then, few cases have been described in the literature. A radiological definition, is the occupation of the hemi-abdomen by the kidney with a midline cross which is the height of five vertebral bodies. GH may be congenital or acquired. The most common presentation of GH is abdominal distention followed by fever and flank pain.

Conclusion: When nephrectomy is indicated in giant hydronephrosis, the laparoscopic trans-peritoneal approach is feasible. Pre-operative decompression using a nephrostomy tube and suspension stitch use facilitate the surgery.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530226PMC
September 2020

Renal Leiomyoma: Case Report and Literature Review.

J Endourol Case Rep 2019 2;5(4):181-183. Epub 2019 Dec 2.

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

Renal leiomyomas are rare benign tumors of the kidney originating from muscle cells. They are usually found by an autopsy, whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, and palpable mass). Today the widespread use of ultrasonography and CT has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histologic examination. Radiologic examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behavior and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 78-year-old man who presented with hematuria and flank pain. We also review the literature and provide a summary of clinical, radiologic, and histologic features of renal leiomyomas.
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http://dx.doi.org/10.1089/cren.2019.0049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383428PMC
December 2019

Does spontaneous renal hemorrhage mandate close surveillance for impending renal cell carcinoma? A case report and literature review.

Int J Surg Case Rep 2020 20;73:44-47. Epub 2020 Jun 20.

Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address:

Introduction: Renal cell carcinoma (RCC) classically presents as a triad of hematuria, loin pain, and a palpable mass. However, Renal cell carcinomas (RCCs) nowadays are more commonly present as incidental findings rather than symptomatic. Wunderlich syndrome is a rare first presentation of RCC.

Presentation Of Case: We present a clinical case of spontaneous renal hemorrhage with unclear etiology that was treated with therapeutic embolization and was found to have renal mass after long follow up.

Discussion And Conclusion: In regards to treating Wunderlich syndrome, some authors favor angioembolization and follow up. Others proposed radical nephrectomy in conditions with no apparent etiology and normal contralateral kidney because of the high incidence of small renal tumors. Spontaneous perinephric hematoma of unknown etiology should be followed up regularly with a CT image for concerning of impending renal tumor.
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http://dx.doi.org/10.1016/j.ijscr.2020.06.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339000PMC
June 2020

Paraganglioma of Urinary Bladder Managed by Laparoscopic Partial Cystectomy in Conjunction with Flexible Cystoscopy: A Case Report.

J Endourol Case Rep 2018 1;4(1):15-17. Epub 2018 Feb 1.

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

Paraganglioma of the urinary bladder (PUB) is exceedingly rare, accounting for <0.1% of all urinary bladder tumors. Various challenging treatment options are available. A 67-year-old female presented with malignant hypertension on four medications for which investigation was done. An observation of having functioning PUB was noted. She was admitted and laparoscopic partial cystectomy was done with the guidance of flexible cystoscopy. She had a smooth postoperative course and was discharged home, then catheter was removed after cystogram. Histopathology confirmed the diagnosis of a bladder paraganglioma. Finally, during the last follow-up, the patient was asymptomatic with controlled blood pressure and normalized catecholamine levels with no evidence of recurrence. PUB is an exceedingly rare tumor that can be managed with minimally invasive techniques such as laparoscopic partial cystectomy with cystoscopy guidance.
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http://dx.doi.org/10.1089/cren.2017.0132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820683PMC
February 2018

Changing Patient Position Can Eliminate Arrhythmias Developing During Extracorporeal Shockwave Lithotripsy.

J Endourol 2016 05;30(5):550-4

1 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto , Toronto, Ontario, Canada .

Introduction: Extracorporeal shockwave lithotripsy (SWL) has a low complication rate. While serious complications are rare, cardiac arrhythmias, such as ventricular tachycardia, may occur. The etiology of these arrhythmias is poorly understood, but it appears to be due to stimulation of the heart by the shock waves.

Objective: This study examines the effect of rotating the patient 15° to 20° when an arrhythmia occurs.

Methods: Eight hundred nineteen patients were prospectively evaluated for arrhythmias during SWL. The initial patient position was dependent on the location of the stone and the body mass index (BMI) of the patient. If a sustained arrhythmia developed, treatment was withheld for 2 minutes and then recommenced. If the patient developed an arrhythmia again, the patient was rotated 15°-20° away from the original position and treatment recommenced.

Results: Twenty patients developed significant arrhythmias during SWL. Arrhythmias occurred more frequently in patients with a lower BMI (p < 0.01), of younger age (p = 0.01), and with right-sided stones (p = 0.035). After the first rotation, 11 patients had no further arrhythmias, and 4 patients had a reduction of their arrhythmia to unsustained minor arrhythmias that did not require cessation of the treatment. The remaining five patients required a second repositioning. Three of these patients required gated SWL to abolish the arrhythmia.

Conclusion: Changing the position of the patient by rotating the patient by 15 to 20° can eliminate arrhythmias that develop during SWL.
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http://dx.doi.org/10.1089/end.2015.0707DOI Listing
May 2016

Intra-corporeal robotic renal auto-transplantation.

Can Urol Assoc J 2015 Sep-Oct;9(9-10):E748-9. Epub 2015 Oct 13.

Division of Urology, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON.

Renal auto-transplantation (RATx) is a suitable option for managing patients with long upper ureteric or pan-ureteric strictures. The current gold standard approach to RATx is a laparoscopic nephrectomy followed by open auto-transplantation. The advent of robotic-assisted laparoscopic surgery has allowed us to apply minimally-invasive techniques to ever-more complex surgical procedures. We present the case of a 38-year-old patient referred to our institution for management of a failed laparoscopic pyeloplasty resulting in a long upper ureteric stricture with complete ureteric obstruction. After complete evaluation, RATx was determined as a suitable management option. Completely intracorporeal right RATx was performed robotically with intraperitoneal cold perfusion. Total operative time was 6.5 hours, with total ischemia time of only 79 minutes (4 minutes warm ischemia, 48 minutes cold ischemia, 27 minutes re-warming time), comparable to the gold standard approach for RATx. To our knowledge, this is the first reported case of a completely intracorporeal robotic RATx in Canada.
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http://dx.doi.org/10.5489/cuaj.3015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662430PMC
December 2015

Transfer of skills on LapSim virtual reality laparoscopic simulator into the operating room in urology.

Urol Ann 2015 Apr-Jun;7(2):172-6

Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, Quebec, Canada.

Objective: Assessing the predictive validity of the LapSim simulator within a urology residency program.

Materials And Methods: Twelve urology residents at McGill University were enrolled in the study between June 2008 and December 2011. The residents had weekly training on the LapSim that consisted of 3 tasks (cutting, clip-applying, and lifting and grasping). They underwent monthly assessment of their LapSim performance using total time, tissue damage and path length among other parameters as surrogates for their economy of movement and respect for tissue. The last residents' LapSim performance was compared with their first performance of radical nephrectomy on anesthetized porcine models in their 4(th) year of training. Two independent urologic surgeons rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Nonparametric spearman correlation test was used to compare each rater's cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the LapSim simulator.

Results: The kappa results demonstrated acceptable agreement between the two observers among all domains of the rating scale of performance except for confidence of movement and efficiency. In addition, poor predictive validity of the LapSim simulator was demonstrated.

Conclusions: Predictive validity was not demonstrated for the LapSim simulator in the context of a urology residency training program.
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http://dx.doi.org/10.4103/0974-7796.150475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374254PMC
April 2015

Validation of the da Vinci Surgical Skill Simulator across three surgical disciplines: A pilot study.

Can Urol Assoc J 2013 Jul-Aug;7(7-8):E520-9

Department of Urology, McGill University, Montreal, QC;

Objective: In this paper, we evaluate face, content and construct validity of the da Vinci Surgical Skills Simulator (dVSSS) across 3 surgical disciplines.

Methods: In total, 48 participants from urology, gynecology and general surgery participated in the study as novices (0 robotic cases performed), intermediates (1-74) or experts (≥75). Each participant completed 9 tasks (Peg board level 2, match board level 2, needle targeting, ring and rail level 2, dots and needles level 1, suture sponge level 2, energy dissection level 1, ring walk level 3 and tubes). The Mimic Technologies software scored each task from 0 (worst) to 100 (best) using several predetermined metrics. Face and content validity were evaluated by a questionnaire administered after task completion. Wilcoxon test was used to perform pair wise comparisons.

Results: The expert group comprised of 6 attending surgeons. The intermediate group included 4 attending surgeons, 3 fellows and 5 residents. The novices included 1 attending surgeon, 1 fellow, 13 residents, 13 medical students and 2 research assistants. The median number of robotic cases performed by experts and intermediates were 250 and 9, respectively. The median overall realistic score (face validity) was 8/10. Experts rated the usefulness of the simulator as a training tool for residents (content validity) as 8.5/10. For construct validity, experts outperformed novices in all 9 tasks (p < 0.05). Intermediates outperformed novices in 7 of 9 tasks (p < 0.05); there were no significant differences in the energy dissection and ring walk tasks. Finally, experts scored significantly better than intermediates in only 3 of 9 tasks (matchboard, dots and needles and energy dissection) (p < 0.05).

Conclusions: This study confirms the face, content and construct validities of the dVSSS across urology, gynecology and general surgery. Larger sample size and more complex tasks are needed to further differentiate intermediates from experts.
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http://dx.doi.org/10.5489/cuaj.419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713157PMC
August 2013