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Biomedical subjects

A A Shokeir

Publications and source records attributed to A A Shokeir.

At least 19 recordsLinked to original sources
PubMed1996

Renal Doppler ultrasound in children with normal upper urinary tracts: effect of fasting, hydration with normal saline, and furosemide administration.

OBJECTIVES: To study the age dependency of renal resistive index (RI) and to study the effect on the renal RI of fasting, intravenous infusion of normal saline, and administration of furosemide in children with normal upper urinary tracts. METHODS: The study included 28 nonobstructed renal units in 15 boys ranging in age from 3 to 11 years. Diuretic renography and Doppler ultrasonography were attempted in all children. Doppler ultrasonography was carried out under three different conditions: fasting state, 30 to 60 minutes after intravenous infusion of normal saline (15 mL/kg), and 10 minutes after administration of furosemide (1 mg/kg; maximum, 40 mg). RESULTS: There was an inverse correlation between age and RI of both renal units under the three conditions of Doppler studies. At fasting state mean RI was 0.70 +/- 0.04, whereas 15 of 28 renal units (54%) had an RI of 0.70 or higher. Intravenous infusion of normal saline significantly decreased the RI to 0.63 +/- 0.04 (P < 0.000001). Injection of furosemide caused a further significant decrease of RI from 0.63 +/- 0.04 to 0.60 +/- 0.04 (P < 0.002). CONCLUSIONS: The renal RI in healthy children is age dependent. In the fasting state, 54% of nonobstructed renal units in children have an RI of 0.70 or higher. Intravenous infusion of normal saline and administration of furosemide can independently cause a significant decrease of the RI in nonobstructed renal units in children.

Child↗
PubMed1996

Doppler ultrasonography in evaluation of potential live kidney donors: a prospective study.

PURPOSE: We compared the accuracy of Doppler ultrasonography and intra-arterial digital subtraction angiography for preoperative visualization of the number of renal arteries in potential live kidney donors. MATERIALS AND METHODS: Intra-arterial digital subtraction angiography and Doppler ultrasonography were used to study the renal anatomy of 64 consecutive kidney donors. Doppler studies were performed without knowledge of the angiographic findings. All donors underwent nephrectomy, and the number of renal arteries at nephrectomy was compared with that predicted by intra-arterial digital subtraction angiography and Doppler ultrasonography. RESULTS: One renal artery was found in 53 harvested kidneys, 2 in 10 and 3 in only 1. Analysis of the data revealed sensitivity 96.2% and specificity 100% for intra-arterial digital subtraction angiography versus sensitivity 100% and specificity 60% for Doppler ultrasound. Overall accuracy was 96.8% for angiography versus 93.7% for Doppler ultrasound, compared to 96.2 and 100%, respectively, for single, and 100% and 60%, respectively, for double renal arteries (p < 0.03). Both tests were interpreted as showing double vessels in the case with triple renal arteries. CONCLUSIONS: Although Doppler ultrasonography is accurate in delineation of single renal arteries, its limited ability to identify multiple arteries should make one cautiously optimistic regarding its current use.

Adult↗
PubMed1995

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): an experimental study in dogs. I. Preliminary results.

OBJECTIVES: To present the preliminary results of a novel technique of ureteroneocystostomy with a new principle (extravesical seromuscular tunnel). METHODS: The new technique was applied in the left ureter of 12 mongrel dogs. The dogs were stratified into three groups (4 dogs each) according to the length of the extravesical seromuscular tunnel. Tunnel lengths of 3, 2, and 1 cm were used for groups I, II, and III, respectively. All the dogs were evaluated by excretory urography, radioisotope renography, and ascending cystography before and at 2 weeks and 3 months after ureteroneocystostomy. Urodynamic evaluation by the Whitaker test and ureteral pressure profile were carried out at 3 months. RESULTS: None of the 12 dogs showed vesicoureteral reflux. All but 1 dog of group I and 2 dogs of group II showed evidence of ureteric obstruction. All 4 dogs of group III showed perfect configuration and function of the corresponding renal units at 2 weeks and 3 months after ureteroneocystostomy. Moreover, the intrapelvic pressure and the superimposed ureteral pressure of this group were approximately similar to pressures of the normal contralateral side. CONCLUSIONS: Preliminary results of this new technique of ureteroneocystostomy revealed that an extravesical seromuscular tunnel of 1 cm provides reflux prevention without obstruction.

Animals↗
PubMed1995

Partial ureteral obstruction: a new variable and reversible canine experimental model.

OBJECTIVES: To develop a new experimental model of partial ureteral obstruction that is simple, reliable, variable, and reversible. METHODS: A 6 F ureteral catheter was inserted into the left ureteral orifice and was cut 2 cm distal to the orifice. The most distal part of the ureter was ligated around the catheter. The catheter lumen was partially obstructed by insertion of stylets of three different diameters. The catheter and the stylet were fixed inside the bladder. The model was tested in 12 dogs, which were stratified into three groups according to the diameter of the obstructing stylet. All the dogs were subjected to intravenous urography (IVU) and technetium-99m-mercaptoacetyltriglycine (99mTc-MAG3) renal scan at 2 and 4 weeks following induction of partial ureteral obstruction. RESULTS: Three different grades of hydroureteronephrosis were obtained according to the diameter of the obstructing stylet. The IVU and 99mTc-MAG3 renal scan studies were repeated at 2 and 4 weeks following removal of the ureteral catheter and ureteroneocystostomy and showed marked improvement in the configuration and function of the corresponding renoureteral units. CONCLUSIONS: Our experimental model fulfills the requirements for a useful model of partial ureteral obstruction, namely, simplicity, reliability, variability, and reversibility.

Animals↗
PubMed1995

Late malignancy in bowel segments exposed to urine without fecal stream.

OBJECTIVES: This study was constructed so as to screen malignant transformation after uroenteric reconstructions using bowel segments exposed to urine without fecal stream for more than 10 years. METHODS: Follow-up data were available for 186 patients who underwent various uroenteric reconstructions using bowel segments exposed to urine without fecal stream for more than 10 years. There were 68 eligible patients with isolated rectosigmoid bladder, 23 with bladder augmentations (15 ileocystoplasty and 8 colocystoplasty), 57 with ileal ureter, and 38 with ileal loop conduit. Besides routine laboratory and radiologic investigations, urine for cytology was obtained from all patients. Moreover, endoscopy and random biopsy of the part of bowel exposed to urine were carried out in all patients. RESULTS: Uroenteric malignancy was diagnosed in 4 patients (2%): 2 adenocarcinoma in an isolated rectosigmoid bladder, 1 transitional cell carcinoma following augmentation colocystoplasty, and 1 squamous cell carcinoma after ileal ureter. None of the patients developed tumors in ileal loop conduits. CONCLUSIONS: Malignant changes do not only occur after ureterosigmoidostomy but are also observed after different uroenteric reconstructions not exposed to fecal stream. Hematuria, ureteral obstruction, and abnormal urine cytology are warning signs of malignancy. Routine cytology is recommended at least yearly beginning 10 years after surgery.

Adenocarcinoma↗
PubMed1995

Ethanol sclerotherapy for symptomatic simple renal cysts.

Twenty-eight patients with 30 symptomatic simple renal cysts were treated by percutaneous aspiration of the cyst and injection of 95% ethanol. All patients were available for follow-up during mean period of 19 (range 14-40) months. In all patients, successful resolution of the cyst with disappearance of the symptoms was observed within 1 month after treatment. During the whole period of follow-up, no patient experienced recurrence of symptoms or required repeat therapy. Of all renal cysts treated, resolution was complete in 25 (83%) and partial (recurrence of < 50% of original cyst volume with no symptoms) in 5 (17%). The degree of response to sclerotherapy (whether complete or partial) correlated significantly with cyst size (P > 0.0008). Major complications were not encountered, while microscopic hematuria was seen in two patients, and low-grade fever was observed in another two. Ethanol sclerotherapy is simple, noninvasive, and highly cost-effective and should be recommended for the treatment of symptomatic simple renal cysts.

Adult↗
PubMed1995

Prostatic abscess in a child.

We report a metastatic prostatic abscess in a 12-year-old boy. Rectal examination revealed a tender, fluctuating prostatic mass, causing acute retention of urine. Prostatic imaging by computerized tomography and transrectal ultrasonography were important in the diagnosis and management.

Abscess↗
PubMed1995

Bladder cancer following ileal ureter. Case report.

We report a case of squamous cell carcinoma of the ileovesical junction 12 years following total replacement of the ureter with ileum. The uroenteric junctions, which are not exposed to the fecal stream, may be associated with cancer as in ureterosigmoidostomy. The urine infected with fecal bacterial flora combined with a healing uroenteric suture line may be responsible for the tumorigenesis. Urine cytology should be performed at least yearly beginning 10 years after ileal ureter. If any abnormality was suspected cystoscopy must be performed.

Carcinoma, Squamous Cell↗
PubMed1995

Further experience with the modified ileal ureter.

A total of 50 patients for whom an ileal ureter was indicated was prospectively randomized between 2 treatment groups according to the surgical technique used. In group 1 the standard ileal ureter procedure was performed, while in group 2 a tailored and valved (modified) ileal ureter was fashioned. Of the patients 19 in group 1 and 23 in group 2 were available for followup of 69 +/- 5.8 months (range 60 to 80). Among the 23 patients in group 2, 5 (22%) experienced reflux due to dessusception of the nipple valve and 4 (17%) had bladder stones. Metabolic acidosis was observed in 9 patients in group 1 (47%) and 4 in group 2 (17%). Urinary outflow obstruction occurred in 5 patients in group 1 and 1 in group 2. Although renal function was comparable among patients in both treatment groups, comparison between patients in group 1 and those without reflux in group 2 showed better renal function in the latter group. We conclude that reflux prevention is of central importance in preservation of renal function in patients with an ileal ureter. A distal nipple valve at the ileovesical anastomosis is associated with significant problems. These observations would urge urologists to search for a more suitable procedure that provides an efficient antireflux principle with minimal adverse sequelae.

Acidosis↗
PubMed1994

Radioisotopic evaluation of renal function in cyclosporine-treated pediatric and adult renal transplant recipients and their living donors. A study of 152 donor-recipient pairs.

Renal function was studied in 2 groups of renal transplant recipients and their donors by technetium-99m diethylenetriamine pentaacetic acid and a gamma camera. The pediatric group (group A) comprised 40 children and their adult kidney donors. The adult group (group B) consisted of 112 consecutive adult renal transplant recipients and their adult donors. All patients received kidneys from living donors and were given the same immunosuppression protocol (PRED plus CSA). Donor glomerular filtration rate (GFR) was determined before nephrectomy and at a mean period of 30 (range 10-50) months after nephrectomy. The graft GFR was measured at 1, 3, 6, and 12 months and at the most recent follow-up visit. Moreover, the functional reserve of the graft was assessed by infusion of dopamine and an amino acid. The postnephrectomy GFR of donors in groups A and B were 74 +/- 18 and 72 +/- 20 ml/min/1.73 m2, respectively. The GFR of pediatric recipients was significantly lower than that of adult recipients at corresponding time points along the course of follow-up. The mean values of graft GFR were 47.6 +/- 20 and 63.8 +/- 29.6 ml/min/1.73 m2 for pediatric and adult recipients, respectively (P < 0.001). Moreover, the graft functional reserve was significantly lower in pediatric recipients. These data demonstrate that adult kidneys transplanted into pediatric recipients have lower GFR than those transplanted into adults, despite corrections for body surface area. Although the reason for this phenomenon is unknown, the observation may have important implications for management of pediatric recipients.

Adolescent↗
PubMed1994

Accidental division of the transplanted ureter during laparoscopic drainage of lymphocele.

We report on the accidental division of the ureter of a transplanted kidney during laparoscopic marsupialization of a symptomatic lymphocele into the peritoneal cavity. Identification of the lymphocele was difficult because of a thick layer of overlying periperitoneal fibrolipomatous tissue. The complication was identified intraoperatively and stented reanastomosis of the divided ureter was performed. Postoperative course was uneventful. To avoid accidental injury to the transplanted ureter during laparoscopic drainage of lymphocele, we recommend that a ureteral catheter be inserted.

Drainage↗
PubMed1994

Tetracycline sclerotherapy for testicular hydroceles in renal transplant recipients.

OBJECTIVES: To study the efficacy of tetracycline sclerotherapy in renal transplant recipients with symptomatic hydroceles. METHODS: A total of 21 patients with symptomatic hydroceles following renal transplantation underwent aspiration of hydrocele and injection of tetracycline hydrochloride. Sclerosant solution was prepared by dissolving 1 g tetracycline hydrochloride powder in 10 mL 1% lidocaine. The amount of sclerosant used depended on the volume of the sac: 5 mL for a sac containing up to 100 mL and 2.5 mL of sclerosant was added for each increase of 100 mL in sac volume. RESULTS: Twelve patients (57%) required only one treatment and 9 patients (43%) had up to 3 injections. The larger the hydrocele, the more treatments were required. The resolution of hydrocele was complete in 12 patients (57%) and partial in 7 (33%) with 2 (10%) failures. Pain at injection was observed in one third of the patients. No major complications (fever, hematoma, infections, abscess, or scrotal necrosis) occurred in any patient. No changes in the structure or size of the testicles were found by ultrasound during an average follow-up period of 35 months. CONCLUSIONS: Tetracycline sclerotherapy is a safe, effective, and economical form of out-patient therapy that can be recommended as primary treatment for hydroceles in patients who have undergone renal transplantation.

Adolescent↗
PubMed1994

Transurethral cystolitholapaxy in children.

Five boys, 5 to 9 (mean 6) years old, who had primary vesical stones underwent transurethral cystolitholapaxy. All stones were disintegrated by the 3F metal probe of the Swiss Lithoclast, which is perfectly adapted to the working channel of the 10F and 12F pediatric cystoscopes. A 13F sheath was then used to wash out the stone fragments. The mean stone diameter was 1.1 cm, and the mean operating time was 15 minutes. A 1-day hospital stay was recorded for all patients with no morbidity. During a follow-up period of 3 to 13 (mean 7) months, there were no micturition disturbances and no urinary tract infections, and uroflowmetry findings were normal. On the basis of this initial experience, we believe that transurethral cystolitholapaxy by Swiss Lithoclast is a potential alternative to cystolithotomy in selected pediatric cases.

Child↗