Publications by authors named "Ziad Nakshabandi"

10 Publications

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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

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

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

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

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

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

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
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