Archive for the Oral

Pelvic reconstructive surgeries for pelvic organ prolapse in female kidney transplant recipients

Mohammad N , Hoda MR, , Fornara P
Clinic for Urology and Kidney Transplantation Center
University Medical School of Halle/Wittenberg, Germany

Pelvic organ prolapse in female postmenopausal kidney transplant recipients may be complicated by adverse events affecting the graft function. We present our experience with pelvic reconstructive surgery in renal transplant recipients.

Material and Methods:

Pelvic reconstructive surgery was performed in 16 female renal transplant recipients with pelvic organ prolapse with or without stress urinary incontinence. Intra- and postoperative data including medical and surgical history, POP-Q measurements, twenty-four hours PAD-count, quality of life measurements and graft outcome were recorded prospectively. Patients were followed for up to 12 months.


Mean age at surgery was 58.3±7.7 years (50−66 years), and the mean distance to renal transplantation was 54.2 ± 15.1 months (range; 38–123 months). A total of 12 anterior and 4 combined anterior/posterior colporrhaphy procedures were performed. Concomitant suburethral single incision transobturator sling procedure was performed in 8 women. There were no bladder and rectal injuries, no bleeding necessitating transfusion and no case of infections. Pelvic floor testing at follow-up of 12 months postoperatively showed only 4 patients (25%) with stage I vaginal wall prolapse. None of the patients had evidence of de-novo incontinence, synthetic sling infection, erosion or rejection. Further, all women reported an improvement in quality of life as measured by SF-36 questionnaire. Renal graft function remained stable in all patients.


Pelvic reconstructive surgery is feasible for management of pelvic organ prolapse in patients with kidney allograft being under immunosuppression. However, concern about impairment of graft function, infection and wound healing remain important.

Prospective non-randomized comparison of surgical invasiveness of extraperitoneal laparoscopic and open retropubic radical prostatectomy

Mohammad N, Hoda MR, Greco F, M Taha, A. Ibrahim Fornara P
Urology department, Assiut University
Clinic for Urology and Kidney Transplantation Center, Halle Saale, Germany

Major surgical procedures cause often a systemic stress response with subsequent changes in hemodynamics and organ perfusion. Laparoscopic surgery has been proposed to result in less induced surgical trauma and a diminished stress response.


To examine perioperative release of inflammatory markers, cytokines and adipocytokines in patients undergoing laparoscopic and open radical prostatectomy.

Design, Setting, and Participants:
A total of 580 patients were enrolled in this prospective, non-randomized study. Blood samples were collected preoperatively, and up to 5 day postoperatively. Serum concentrations of acute phase markers (CRP and SAA), interleukins (IL-6, IL-10) and adipocytokine leptin were measured at each time-point by means of ELISA. Clinical data were collected by reviewing patient’s records.


Laparoscopic extraperitoneal radical prostatectomy (LRP) was performed in 286 patients (group I), open retropubic radical prostatectomy (RRP) in 294 patients (group II).

Results and Limitations:
LRP resulted in less bleeding (p<0.05), faster recovery (p<0.05) and less duration of catheterization (p<0.05). There were no significant differences in the oncological outcome of patients treated by RRP or LRP in our series. Patients undergoing LRP had significantly lower IL-6 and adipocytokine levels at all measurement time-points. However, a biphasic kinetics of adipocytokine serum levels has been observed during the postoperative course in all patients. Further, there was a direct correlation between plasma levels of leptin and CRP as well as SAA, and an inverse relationship between plasma levels of leptin and inflammatory cytokines, suggesting a role for adipocytokine in initiation of systemic stress reaction to surgery.


Laparoscopic radical prostatectomy was associated with lesser extend of adipocytokine and IL-6 release indicating a smaller degree of surgical insult and the minimal-invasive nature of this procedure. Further, adipocytokines could serve as new marker of invasiveness in major urologic surgery.

Double face onlay island preputial skin flap with augmented glanuloplasty for hypospadias repair

Zaki M. El dahshoury, Wael Gamal, Mohmad Mostafa. Ahmad Rashed Hammady.
Urology dept. Sohag University hospital.


The aim from this study is the evaluation of the use of double face preputial flap with augmented glanuloplasty in repair of different degree of anterior hypospadias.
Material and methods:
Prospective study on 182 male patients with different degree of anterior hypospadias, were treated with double face onlay island preputial flap. Their age ranged from 6ms-10ys (mean 3.03ys). Cases that were selected for this study,  those with anterior hypospadias (122 with DPH, 38 with mid penile hypospadias and 22 with proximal penile hypospadias, all with small glans, narrow urethral plate. All patients were treated with double onlay island preputial flap, the inner mucosa as onlay to augment the urethra and the outer face to cover the neourethra and augment the glanular wings. Suitable urethral catheter was inserted for 5-7 days. Follow up for 24months was by clinical examination. VCU and AUG are indicated for cases with history suspecting stricture.


Success rate was in 176  (96.6%) patients regarding the cosmosis and the patency of urethra, 3 (1.6%) patients had superficial epidermal loss which healed spontaneously after 3 weeks without any effect on urethral patency and cosmosis. 6 (3.29%) patients had developed actual complications affecting the success rate, 1(0.5%) patient with glanular disruption, 2(1.09%)  patients with urethrocutaneous fistula, 1 (0.5%) case with mid penile urethral diverticulum and 2 (1.09%) patients with lateral penile torsion.


Double face onlay preputial flap with augmented glanuloplasty is a suitable technique for repair of anterior hypospadias as it gives satisfactory success rate as regard urethral patency and cosmesis.


Hypospadias, double face onlay island flap, augmented glanuloplasty, flap hypospadias repair.

Role of injection of 100 units of botulinum toxin-A in management of refractory idiopathic overactive bladder

Elbadry M.S.B. , Abdelmalek M.A. and  Gabr A.H.,
urology department, minia university

Overactive bladder (OAB) is a bothersome condition affecting the quality of life, financial constraint on the individual, and community. Anticholinergic drugs cannot be used for long term due to adverse side effects. Botulinum toxin has recently shown promising and encouraging result in management of OAB however Botulinum toxin injection is still not in common use due to financial load over the patient.


Aim was to study the safety, efficacy, tolerability, and duration of effect of 100 units only of botulinum toxin in refractory idiopathic detrusor overactivity.

Materials and Methods

Thirty-nine female patients (average age of 52 years) clinically and urodynamically diagnosed as idiopathic OAB were injected 100 units of botulinum toxin-A mixed with 20 ml of normal saline, intradetrusally at the rate of 1 mL at each site for 20 such sites sparing the trigone and ureteric orifices. Follow up at 3rd, 6th, 9th, and 12th month with clinical and urodynamical questionnaire was done.


There were 4 dropouts and 35 patients were evaluated, of which 30 patients (85.7%) showed improvement in clinical features like frequency, urgency, nocturia, and incontinence within 1 week of injection, which lasted for mean period of 7 months (varying from 6 to 9 months). Volume at first desire to void improved from median baseline of 104-204 ml and maximum cystometric capacity of bladder increased from mean baseline value of 205-330 ml. The detrusor pressure decreased by 49% from the baseline and postresidual urine volume increased by 30% of maximum cystometric capacity of bladder. There was no adverse effect on our patient.


Intradetrusor injection of 100units of Botox-A in management of refractory overactive idiopathic bladder is not only safe and well tolerated, but also very effective with practically no side effects however, shorter period of improvement were observed.

The Antioxidant Nitrous Oxide Synthetase Enzyme Expression in Bilharzial and Non-bilharzial Bladder Lesions

Mamdouh M. Abol-Nasr, Alayman F. Hussain, Ateeg M. Algarni*, Fahad Alfhaidi*, Tahya H. Selim** 
Urology Department, El-Minia University, Egypt; Prince Salman Hospital, Riyadh, KSA*; and Biochemistry Department, Assiut University**

Purpose: Antioxidant enzymes protect against the diverse effects of the dangerous free radicals and other oxidative stressors involved in carcinogenesis.  The nitrous oxide synthetase serum activity in patients with benign bladder lesions, patients with malignant bladder lesions, and normal individuals was evaluated.

Materials and Methods: This study included 76 adult patients: 64 males and 12 females, with an overall mean age of 55 years. Patients were divided into two groups based on pathology and/or cystoscopy findings. The first group included 23 patients proved to have benign bladder lesions The mean age of these patients was 52.9±10.6 years. The second group included 53 patients, proved to have malignant bladder lesions and their mean age was 55.2±9.87 years. A control group was selected and included 15 adult individuals well-matched with both groups as regard age, sex and special habits .  The serum level of nitrous oxide synthetase (NOS) enzyme activity was determined in laboratory, for the three groups, by means of using kits supplied by biodiagnostic that assay nitrous oxide breakdown products (nitrite and nitrate) serum levls using a procedure based on the Griess’ reaction.

The mean serum level of (NOS) activity in both patients with benign bladder lesions and patients with malignant bladder lesions was significantly higher than that in the control individuals. The mean serum level of (NOS) activity in patients with bladder malignancy was significantly higher than that in patients with benign bladder lesions. Also, the mean serum level of (NOS) activity in patients with malignant bilharzial bladder lesions was significantly higher than that in patients having benign bilharzial bladder lesions. But, there was no significant impact for the presence or absence of bilhrziasis on the level of (NOS) activity in patients with malignant bladder conditions.   

The nitrous oxide synthetase is expressed in patients with bilharzial bladder lesions especially in malignant ones. It might have a tumoricidal role on the bladder malignant conditions in the bilharzial and the non-bilharzial patients.  These findings indicate a possible role of nitrous oxide synthetase enzyme in the protection of bladder urothelium against carcinogenic changes.

Tissue Engineering of Cavernous Tissue for Treatment of Erectile Dysfunction

Hazem Orabi1, Tom Lue2
Urology Department, Assiut University ,Egypt
Urology Department, University of California San Francisco, USA

Introduction and Objectives :
As one-third of erectile dysfunction(ED) patients do not respond to phosphodiesterase
5 inhibitors, the demand for new therapeutic options continues to rise . Adipose
tissue-derived stem cells (ADSCs), being easily harvested and cultured, represent
ideal source for ED treatment. The aims of this study were to investigate if ADSCS
can be differentiated into smooth muscle cells (SMC) and endothelial cells (EC) and
constructed into cell cavernous tissue in vitro and if this tissue can survive and
integrate after its implantation in the penis.

Rat ADSCs were isolated, expanded and induced into SMC and EC using
TGF-β1 and endothelial growth medium-2, respectively. The phenotype of induced
cells were checked using morphology, immunocytochemistry and western blot for
SMC and EC markers. The cells were labeled with EdU and used to construct
cavernous tissue by culturing them in thermosensitive dishes for 7-10 days. The
cavernous tissue was harvested by lowering the temperature. Part of the cavernous
tissue was used for histologic assessment while the other part was implanted under
tunica albuginea of rats. The histologic assessment of the cavernous tissue included
H&E and Masson Trichrome staining, immunohistochemistry for SMC and EC. The
formation of extracellular matrix was tested using Picrosirius and collagen IV staining.
The rats were sacrificed after 4 weeks and penis and bone marrow were collected to
assess cell survival and integration into the penile tissue.

The induced cells showed positive staining for SMC and EC markers. The western
blot confirmed their phenotype. The formed cavernous tissue exhibited architecture
similar to rat penis with confirmed phenotype of the viable SMC and EC.
Extracellular matrix formation was evident after positive staining for Picrosirius Red
and collagen IV staining. The tissue cells implanted in vivo survived and incorporated
into penile tissue.

The results showed the ability of ADSCs to differentiate into SMC and EC and form
cavernous tissue in vitro similar to penile tissue. The implanted tissue can survive and
integrate into the penile tissue.The cavernous tissue made of ADSCs forms new
technology for improvement of erectile dysfunction. In vivo studies in diseased
animal models are needed to verify the its therapeutic potential

Characterization of morbidity of double J ureteral stents in the current practice

Mursi K; Aboul Ela A; Shannan K; Hegazy A; El-Feel A
Department of Urology, Cairo University, Cairo, Egypt

Introduction & objectives:
To characterize the morbidity of double J (DJ) ureteral stents in the modern endoscopic practice.

Materials & methods:
A total number of 72 adult patients were prospectively enrolled in this study. Selection criteria included unilateral DJ fixed for hydronephrosis, stricture ureter, in conjunction with ESWL or after endoscopic procedures. Patients were asked to comply with follow-up assessment, which were conducted at specific intervals during the follow up period (1st week, 2nd week, 4th week and monthly thereafter) as well as at the time of DJ extraction (before DJ removal, at the time of DJ removal and 4 weeks after DJ removal), which was defined as the endpoint of the study.

A total of 67 patients (93%) have completed the study with mean stent dwelling time 3.74 + 3.30 months (range 1 – 10 months). Table 1 illustrates the results of the current study. Dysuria (94%) was the most prevalent lower urinary tract symptom, while loin pain (83%) was the most distressing symptom in our patients. Statistical analyses have revealed significant improvement in dysuria, urgency, hematuria, as well as loin pain both before and after DJ removal. Improvements in the frequency of micturation, incontinence, supra-pubic pain and fever were only statistically significant after DJ removal. Radiological evaluation revealed improvement in the degree of hydronephrosis from 70% by 1st week to 49% before DJ removal (p=0.009), and 19% after DJ removal (p=<0.0001). Laboratory investigations also revealed significant improvement in microscopic hematuria before and after DJ removal, while improvement in pyuria and crystalluria were only significant after DJ removal.

Despite the morbidity of DJ stents, much of these morbidities have resolved significantly, whether before or after DJ removal. Efforts must continue to develop the ideal DJ stent.

Table 1: Characterization of DJ morbidity in the study group

Symptoms 1st week    (n=37) 2nd week (n=37) 4th week (n=36) Before removal (n=37) 4 weeks after removal (n=37)
63 (94%) 57 (85%) 56 (83%) 52 (77%)
20 (30%)
29 (43%) 29 (43%) 21 (31%) 18 (27%)
3 (5%)
23 (34%) 23 (34%) 17 (25%) 14 (22%)
0 (0%)
7 (10%) 7 (10%) 4 (6%) 4 (6%)
0 (0%)
32 (48%) 23 (34%) 22 (33%) 18 (27%)
0 (0%)
Loin pain
56 (83%) 49 (73%) 35 (52%) 38 (57%)
11 (16%)
Supra-pubic pain
38 (57%) 38 (57%) 37 (55%) 34 (50%)
5 (7%)
Urethral pain
14 (22%) 13 (19%) 19 (28%) 18 (27%)
0 (0%)
16 (24%) 9 (13%) 5 (7%) 9 (13%)
3 (5%)

(* = p-value <0.05 is considered statistically significant)

Tuberculous Prostatitis in Cystoprostatectomy Specimens of Bladder Cancer Patients with History of Intravesical BCG Instillation

Tamer S Barakat, Bedeir Ali-El-Dein, Mohamed Elsaadany and El-Housseiny I Ibrahiem.  
Urology & Nephrology Center, Mansoura Uni versity, Mansoura, Egypt

Objectives: To assess the incidence of granulomatous (tuberculous) prostatitis in cystoprostatectomy speciemens of patients with previous intravesical BCG instillation and to answer the question: is further anti-tuberculous treatment needed after surgery?

Patients and Methods:
Between March 2002 and December 2010, we reviewed the pathology of 150 patients who underwent cystoprostatectomy because of failure of intravesical BCG for non-muscle invasive bladder cancer (NMIBC). Patients were interviewed and data reviewed regarding pre-operative symptoms suggestive of prostatitis, intra-operative findings, post-operative course and fever.  Post-operative follow-up for evidence of tuberculosis was performed by Zeil Neilson (ZN) and PCR in urine after 6 months. At the same time, chest CT was carried out.

Follow-up ranged from 24 to 60 months with a mean of 30. Out of the whole series, 20 patients (13.3%) showed tuberculous granulomatous prostatitis in the cystoprostatectomy speciemen. Two patients showed post operative fever not responding to antibiotics and therefore, isoniazid and rifampicin (anti-tuberculous) treatment was given for 6 months with good response. The remaining 18 patients had uneventful post operative course, negative PCR and ZN and negative chest CT did not receive any further treatment. So far, they remained free of pertinent symptoms and ZN, PCR and chest CT remained negative.

The rate of tuberculous prostatitis after intravesical BCG instillation in cystoprostatectomy speciemens is 13.3%. Routine post-cystoprostectomy anti-tuberculous treatment is not advised if there are no clinical manifestations suggestive of TB before or after the operation, no evidence of associated tuberculous lymphadenitis in the specimens and ZN, PCR and chest CT are negative.

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