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Biomedical subjects

H Abol-Enein

Publications and source records attributed to H Abol-Enein.

16 recordsLinked to original sources
PubMed1998

Primary adenocarcinoma of the urinary bladder: a report of 185 cases.

OBJECTIVE: To evaluate the outcome after the treatment of primary non-urachal vesical adenocarcinoma and to determine the significant prognostic factors. PATIENTS AND METHODS: The records of 185 patients with vesical adenocarcinoma were reviewed. The pathological evaluation included the determination of pathological stage, tumour grade, presence or absence of mucin and its location, evidence of bilharzial infestation and flow-cytometric DNA analysis. The mean follow-up of the treated patients was 3.1 years. Disease-free survival was estimated and the results correlated with patient and tumour characteristics (univariate analysis). Cox's proportional hazards analysis was used to determine prognostic factors. RESULTS: The overall 5-year disease-free survival was 55%; only three factors had a significant impact on survival, the tumour pathological stage and grade, and lymph node involvement. CONCLUSIONS: Radical cystectomy remains the only satisfactory treatment option for primary vesical adenocarcinoma. Tumour stage, grade and lymph node involvement are the only significant prognostic factors.

Adenocarcinoma↗
PubMed1997

Urinary diversion in children and young adults using the Mainz Pouch I technique.

OBJECTIVES: To determine the late complications and consequences for renal function, vitamin and acid-base metabolism after application of the Mainz Pouch I (MZP-I) technique in children and young adults. PATIENTS AND METHODS: To November 1994, the MZP-I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (< or = 20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow-up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1-10.5). RESULTS: At the last examination, 23 of 55 (42%) preoperatively dilated RUs had improved. 131 of the 163 RUs (80%) were stable and nine RUs (5.5%) showed a slight clinical asymptomatic increase in the upper tract dilatation. Through an extraperitoneal flank incision, 11% of the RUs which developed stenosis at the ureterocolic anastomosis were successfully reimplanted (16% in patients with neurogenic disorders, 17% with pre-operative irradiation and 5% in the remaining patients). Two of 32 patients with an intussuscepted and invaginated ileal nipple required re-operation due to incontinence, but none of the patients with an appendiceal stoma were incontinent. Open revision of a stomal stenosis was performed in three and endoscopic treatment in nine patients. In 54 patients, the levels of vitamins A, B1, B2, B6, E, folic and bile acid were within normal ranges. There was no significant decrease in vitamin B12 levels after operation. In none of the patients with normal pre-operative creatinine values had the levels increased and none developed severe acidosis or bowel neoplasm. CONCLUSION: The MZP-I is recommended as a technique for bladder augmentation or continent urinary diversion in children and young adults, with an acceptable complication rate which offers long-term protection of the upper urinary tract.

Acid-Base Equilibrium↗
PubMed1997

Double folded rectosigmoid bladder with a new ureterocolic antireflux technique.

PURPOSE: We present a new method of urinary diversion to the rectum. MATERIALS AND METHODS: Between 1992 and 1995 a new surgical procedure was used in 32 women, 20 men and 12 children 3 to 60 years old (mean age plus or minus standard deviation 35.4 +/- 2.2). The main indication for diversion was invasive bladder carcinoma. Surgery entailed creation of an S-shaped double folded rectosigmoid reservoir with implantation of the ureters via an extramural serous lined antireflux technique. RESULTS: One patient died of a massive pulmonary embolism postoperatively. Followup ranged from 6 to 36 months (mean 19.2 +/- 7.0). During the observation period 6 patients died of local recurrence and/or distant metastasis within 8 months. Of the patients 57 are currently evaluable. All patients are continent during the day with an emptying frequency of 2 to 4 times. Nocturnal enuresis was observed in 4 children who responded favorably to imipramine hydrochloride therapy. Upper urinary tract function was maintained or improved in 95% of the patients. No clinical evidence of acidosis was observed, since all patients were kept on prophylactic oral alkalization. CONCLUSIONS: The procedure can circumvent some of the inherent disadvantages of ureterosigmoidostomy and is a good alternative to orthotopic bladder substitution when the urethra cannot be used.

Adolescent↗
PubMed1996

The ileopsoas tunnel, a new antireflux technique for ureteroileal reimplantation: an experimental study in dogs.

A new antirefluxing ureteroileal anastomosis is described in which the implanted ureter is placed between the ileal segment and psoas muscle. The procedure was studied in eight experimental dogs, which were observed for 20 weeks. Radiologic and bacteriologic examinations, necropsy assessment and histopathologic results provided evidence that this ileo-psoas tunnel technique allows a unidirectional, non-obstructed flow of urine. The technique could be applied when ileal replacement of the ureter is necessary or in association with continent bladder replacement.

Anastomosis, Surgical↗
PubMed1996

Long-term renal morphology and function following enterocystoplasty (refluxing or anti-reflux anastomosis): an experimental study.

OBJECTIVE: To study the morphology and function of the upper urinary tract over the long-term in dogs with an enterocystoplasty and a refluxing or anti-refluxing uretero-intestinal anastomosis. MATERIALS AND METHODS: Subtotal cystectomy and "cup" ileocystoplasty were performed in 13 dogs. The right ureter was implanted into the cystoplasty with a refluxing technique in seven and with an anti-reflux procedure in six dogs. The left renal unit acted as an intact control in 11 dogs, while in two the intramural part of the left ureter was incised to produce reflux. Thus, of the 26 renal units, nine had a refluxing junction (anastomosis), six were anti-refluxing and 11 served as intact controls. Total and separate glomerular filtration rates (GFRs) were measured preoperatively and regularly thereafter, and cystometry, urography and ascending enterocystography were performed. At necropsy, urine was obtained for culture from the cystoplasty and renal pelves, and both kidneys were examined histologically. RESULTS: The cystometric pressure was low in 12 of the 13 dogs: urography showed no obstruction. The fall in separate GFR did not differ significantly among the groups (with and without reflux protection, and control units). Reflux was detected in three of nine renal units with refluxing anastomosis and in three of 11 control units. Bacteriuria was found in the cystoplasty in all dogs; the incidence in the upper urinary tract was seven of eight renal units with a refluxing anastomosis, one in five of those with an anti-refluxing anastomosis and three of nine control units. Pyelonephritis was found in none of the control kidneys, in six of nine kidneys with a refluxing and in two of six with an anti-refluxing anastomosis: it was less severe in the latter. CONCLUSION: Refluxing ureteric implantation in a low-pressure enterocystoplasty was commonly associated with bacteriuria in the upper urinary tract and with pyelonephritis. Thus, anti-reflux implantation was beneficial for renal preservation in this setting.

Animals↗
PubMed1995

Serous-lined extramural ileal valve as a new continent cutaneous urinary outlet: an experimental study in dogs.

A new technique for the construction of a cutaneous continent catheterizable outlet suitable for urinary reservoirs is presented. The technique entails the creation of an ileal reservoir outlet by implantation of a tapered ileal segment into a serous-lined extramural tunnel. The procedure was carried out in eight experimental dogs, and the results were compared with a control group of five dogs for which a nontunnelled tapered ileal outlet draining a similar reservoir was constructed. Clinical, radiological and urodynamic evaluation provided evidence that this new outlet is easily catheterizable. Its continence mechanism is more reliable than that of a simple tapered outlet.

Animals↗
PubMed1995

Further clinical experience with the ileal W-neobladder and a serous-lined extramural tunnel for orthotopic substitution.

OBJECTIVE: To report on the functional results following orthotopic substitution using an ileal W-neobladder with an extramural serous-lined tunnel for reflux prevention. PATIENTS AND METHODS: Sixty men (mean age 46 years) underwent a one-stage radical cystoprostatectomy and an ileal W-neobladder for invasive bladder cancer. The technique entails the creation of two serous-lined extramural tunnels in a detubularized ileal W-bladder fashioned from 40 cm of the terminal ileum. Fifty-one patients were evaluable, with a minimum follow-up of 2 years. Evaluation of patients included clinical, radiographic and urodynamic studies. RESULTS: There was no operative mortality and no gross morbidity. The upper tracts remain unchanged or improved in 97% of the implanted renal units. Reflux was not observed in any patient. The incidence of day and night continence was 90 and 80%, respectively. CONCLUSION: The technique provides a non-obstructed unidirectional uretero-ileal re-implantation, in a low-pressure system constructed from a short ileal segment. No staples were required.

Cystectomy↗
PubMed1994

A novel uretero-ileal reimplantation technique: the serous lined extramural tunnel. A preliminary report.

A novel technique for an anti-refluxing uretero-ileal reimplantation entailing creation of 2 serous lined extramural tunnels in a detubularized ileal W-bladder is presented. The operation was done on 12 patients in whom an orthotopic bladder substitute was indicated. Mean followup was 18 months. Evidence indicated that this method could provide a nonobstructed unidirectional flow of urine in all of the examined renal units.

Humans↗
PubMed1993

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. I. Evaluation of the Le Duc technique.

Experimental evaluation of uretero-ileal reimplantation was carried out in 10 adult mongrel dogs. One half of the ureters (10) were implanted into ileal reservoirs using the classic Le Duc technique. In the other half, the implanted ureters were covered by ileal mucous membrane. Following the classic Le Duc technique, 40% of the reimplanted ureters showed evidence of either reflux and/or stenosis resulting from shortening and fibrosis of the tunnel. The remaining 60% were perfect due to spontaneous nipple formation at the implantation sites rather than to creeping of the intestinal mucosa. In contrast, none of the ureters examined was either refluxing or stenotic. This study outlines the critical importance of covering the implanted ureters with mucosa to avoid the ureteric adventitia being exposed to the irritative effects of urine with subsequent scarring.

Animals↗
PubMed1993

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. II. Influence of exposure to urine on the healing of the ureter and ileum.

The influence of exposure to urine on the ureteric adventitia and the ileal mucous membrane was studied in 10 mongrel dogs. When the ureter was implanted freely into the lumen of the bladder its adventitia became the seat of granulation tissue formation. This is later covered by creeping of transitional epithelium lining the ureter, forming what is in effect a ureteral nipple. Final healing is associated with an unpredictable amount of scarring. Furthermore, it was noted that healing and creeping of the ileal mucous membrane are impeded in the presence of urine. The sum of these effects is that ureters implanted in an open sulcus of the small intestine are not covered by intestinal epithelium, they tend to form spontaneous nipples and their healing is associated with either stenosis or reflux in some 30% of cases.

Animals↗
PubMed1993

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. III. A new antireflux technique for uretero-ileal anastomosis: a serous-lined extramural tunnel.

A new antireflux uretero-ileal reimplantation technique suitable for use with bladder substitutes is presented. This procedure entails creation of a serous-lined extramural tunnel. Following detubularization of the bowel segment, the adjacent flaps are approximated by continuous 4/0 non-absorbable sutures 1.5 cm from the cut edges. The ureters are laid in the trough thus fashioned. "Button-holes" are created in the bowel flaps and a mucosa-to-mucosa uretero-ileal anastomosis is carried out. The mucosal edges of the flaps are then approximated by one layer of continuous 4/0 (PGA) suture resulting in closure of this artificial tunnel. The feasibility and functional outcome of this technique were experimentally investigated in 8 dogs. Follow-up was carried out up to 30 weeks. Assessment by intravenous urography and ascending studies showed that the procedure is an efficient method of providing an unobstructed unidirectional flow of urine.

Animals↗