Archive for the Oral

Single port laparoscopy: Current Alexandria Experience

Aly M. Abdel-Karim, Ahmed Moussa, Ahmed Aboul-Fettoh, Waleed Dawood, Mostafa Elmissery, Mohamed Hassouna and Salah Elsalmy
Urology Department, Alexandria University, Alexandria, Egypt

Introduction:
There are increasing reports in the literature about use of single port laparoscopy in urology.  Herein, we present our current experience of single port in Urology.

Methods:
From April 2010 till July 2011, 10 different urologic pathologies have been treated by single port laparoscopy.  Most of cases were treated by using both triport and quadriport and pre-bent instruments. Data were compared with that of the relevant conventional laparoscopic procedures.

Results:
There was no conversion to conventional laparoscopy in any of the single port laparoscopic procedures.  Compared with relevant conventional laparoscopic procedures, single port laparoscopy was associated with comparable operative time, less postoperative pain, less postoperative hospital stay with no added risk or complications.

Conclusions:
Single port laparoscopic surgery is technically feasible and effective for treatment of various urologic pathologies. However, prospective comparative studies are required to directly compare single port laparoscopy with conventional laparoscopy.

Long term outcome of redo hypospadias repair

Ahmed S Safwat1, Hisham Hammouda1, Nabil K Bissada2
Division of Pediatric Urology, 1Assiut University, Egypt and 2University of Arkansas for Medical Sciences, Little Rock, AR, USA


Introduction and Objective:
Management of failed hypospadias repair is challenging for hypospadiologists. Herein, we report a long-term experience with redo hypospadias repair.

Methods:
A total of 37 patients with previous failed hypospadias repair were managed from February 2004 to September 2009. Patients’ data were analyzed regarding age, number of previous repairs, meatal location, procedure performed, operative time, complications. Patients were followed up from 2-67 (mean 34 months).

Results:
Patients’ age ranged from 15-204 (mean 90.7 months). Thirty patients had one previous hypospadias repair, six with previous twice repair and one patient with previous four repairs. Urethral meatus was coronal in 8, distal penile in 5, mid-penile in 6, peno-scrotal in 7, scrotal in one and perineal in ten patients. Of the 37 patients, 11 underwent a staged buccal mucosal graft (BMG) urethroplasty, 12 onlay island flap, 11 parameatal flap, two Theirsh-Duplay and one tabularized preputial flap. Operative time ranged from 67-446 min (mean 157 min). Complications were encountered in 7 (18.9%) in the form of graft contracture in two (necessitating redo graft urethroplasty), meatal stenosis in one (managed with meatoplasty), urethral stricture in the tabularized flap patient requiring resection reanastomosis for the strictured segment, urethra-cutaneous fistula in one that required active closure after 6 month, bleeding in one (controlled by compression) and skin disruption in one that healed without consequences. The final complications rate was 13.5%.

Conclusions:
The characteristics of BMG make it suitable for urethroplasty in the absence of donor tissues. Whenever possible, avoidance of tabularized flaps is recommended. A long-term follow up for redo hypospadias repair is required to assess the late occurrence of neourethral stenosis.

Transplantation in the pediatric age group

Ahmed Kodera
Cairo university, Urology Department, Cairo, Egypt


Between January 2004 and May 2010, fifty pediatric patients underwent renal transplantation at King Fahd unit. We retrospectively reviewed the files of the patients who transplanted before the beginning of our study (June 2006) and followed them up and the rest of the patients were followed up prospectively. All of our patients were under 18 years of age and had their kidneys from related or unrelated living donation. The mean age was 12.2 years (range 3 to 17). The primary causes of ESRD were aplastic/hypoplastic kidneys, reflux and obstructive uropathy. All cases were first grafts. Immunosuppression used was cyclosporine, steroids and azathioprine or mycophenolate mofetil. Patients were followed up from 6 to 113 months. There was no delayed function in the immediate post-transplant period. Postoperative surgical complications were lymphocele (4 cases), early ureteral obstruction and leakage (1 case) and vascular complications (5 cases). Infections were the main medical complications, primarily UTI, followed by pulmonary infections. Acute rejection episodes were reported in 34% of patients; 88 % of which were steroid sensitive. One, 3-year, 5-years graft survivals were 90.5%, 88% and 83.3%, respectively. Two patients died, one died of systemic sepsis and the other died of cardiac arrest during dialysis. Close intensive follow up and counseling of both child and parents were very important to prevent noncompliance and for early detection and treatment of rejection episodes and infections, to prevent early graft failure.

Keywords: Renal failure, pediatric transplantation, living donors

DO WE STILL HAVE TO IMAGE FOR IMPALPABLE TESTIS?

Ahmed H. Gabr, Mohamed S. Elbadry, Lotfy Abdelkader, Mohamed Abdelmalek
Urology Department, Minia University

INTRODUCTION AND AIM OF WORK:
Cryptorchidism is one of the most common congenital anomalies of the male reproductive system, affecting3% of full term male newborns and 0.8% of male infants at 1 year of age. It is considered one of the most confusing topics in pediatric urology concerning its pathogenesis, evaluation and management. . Various diagnostic modalities are available for localization of the impalpable undescended testis as Ultrasonography, computed tomography scan, magnetic resonance imaging and testicular angiography. There are many factors to be put in mind before the use of any of them like the accuracy of each technique compared to the other, the invasiveness of the technique, the amount of radiation exposure, the availability, in addition to costs. The advent of laparoscopic surgery encouraged surgeons to use laparoscopy for both the diagnosis and treatment of impalpable testes as an alternative to open surgery with minimal morbidity, short hospital stay and better cosmetic outcome.
The aim of this work is to study the value and accuracy of various available modalities for diagnosis of impalpable undescended testis.

PATIENTS AND METHODS:

Thirty two cases ,with a mean age of 3.6 years, of clinically impalpable undescended testis were included in this study that was performed in Minia University Hospital in the  period from June 2009 to June 2011. All these patients had clinically impalpable unilateral testes, 17 on the right side and 15 on the left side. All patients were subjected to careful clinical examination then Ultrasonography, multislice C.T and MRI and then lastly laparoscopy.

RESULTS:

Ultrasongraphic examination detected 10 cases; eight of them were detected in the inguinal canal, of which 5 were high in the inguinal canal and 3found low in the inguinal canal and neck of the scrotum. C.T. detected sixteen cases; in 9 cases it was located intraabdominal, either pelvic in 5 cases just proximal to the inguinal canal by about 2cm on the surface of the external iliac vessels or high intra-abdominal in the other 4 cases. In seven cases the testis was detected in the inguinal canal. MRI detected eighteen cases, 11 cases were detected intra-abdominal and 7 cases were Intracanalicular. Diagnostic laparoscopy located 24 testes out of  32 impalpable testes. The remaining 8 cases were considered absent as the vas and vessels were followed till their end with no testes detected (blind ended).

CONCLUSION:

Careful physical examination is the corner-stone in testicular localization. Imaging techniques have varying degrees of successful localization of impalpable testis. Laparoscopy for the impalpable undescended testes offers a simultaneous diagnostic and therapeutic tool. It obviates the need for invasive and/ or expensive diagnostic imaging.


Abstract Book

Login



Signup Here
Lost Password

The EUA This Month

 

This site is
intended for health care professionals


Copyright 2010 © URO-Egypt.com. All rights reserved