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Biomedical subjects

P F Nasrallah

Publications and source records attributed to P F Nasrallah.

At least 19 recordsLinked to original sources
PubMed2001

Management of grade IV renal injury in children.

PURPOSE: Conservative nonsurgical management of major renal trauma in children is well established. However, when blunt trauma is accompanied by significant urinary extravasation, options are less than clearly defined. Endoscopic techniques, such as stents and percutaneous drainage, have not been widely used because of small caliber. We present our experience with endoscopic management of grade IV renal trauma. MATERIALS AND METHODS: From 1983 to 1996, 15 children satisfied the criteria for grade IV renal trauma. We retrospectively reviewed the charts to assess the mechanism of injury, associated injury, treatment, hospital stay and transfusion requirement. Patients were followed clinically with blood pressure and creatinine monitoring, and by radiograph with computerized tomography. RESULTS: Nine patients with isolated kidney injury were successfully treated with observation, 1 underwent early partial nephrectomy for persistent anemia and hypotension, and 5 had a urinoma, which was successfully treated with percutaneous drainage only in 2. The other 3 patients underwent cystoscopy and ureteral stent placement for high drainage output, leading to the resolution of urine leakage. In 1 patient who underwent percutaneous drainage only renovascular hypertension developed, requiring partial nephrectomy 3 months after the original injury. The remaining 13 patients had complete radiographic resolution of the injury and no evidence of hypertension. CONCLUSIONS: In the pediatric population grade IV blunt renal trauma usually resolves without intervention. When a symptomatic urinoma develops, percutaneous drainage, accompanied at times by ureteral stenting provides the complete resolution of persistent urine leakage.

Adolescent↗
PubMed1999

Chordee: varied opinions and treatments as documented in a survey of the American Academy of Pediatrics, Section of Urology.

OBJECTIVES: Consensus has not been established as to the best treatment of congenital chordee. Outcomes analysis of treatment options are limited by the prevailing use of ambiguous terminology. We sought to clarify the frequently used term "significant chordee" and to measure the utilization of current treatment strategies. METHODS: A survey covering current practice patterns concerning congenital chordee with hypospadias was sent to 236 members of the American Academy of Pediatrics, Section of Urology. RESULTS: Correction of chordee was the primary concern in hypospadias surgery of 31 % of those responding, but it was not the primary goal of 54% of respondents. Findings indicate that "significant chordee" is clinically defined as curvature greater than 20 degrees, in that 75% of respondents said they would proceed with further intervention. Placement of plicating sutures was the most common therapy chosen for 20 degrees chordee, with 50% of respondents electing this approach. Consensus was reached at 30 degrees chordee, with greater than 99% intervening at this degree of curvature. At 30 degrees curvature, 48% used an incisional Nesbit procedure. As the degree of curvature increased, division or mobilization of the urethral plate became the most common intervention. With 50 degrees chordee, urethral plate manipulation was used 34% of the time. Sixty percent of the respondents believed the urethral plate did not often contribute to chordee. CONCLUSIONS: "Significant chordee" was believed to be a curvature greater than 20 degrees to 30 degrees. With 20 degrees, 30 degrees , and 40 degrees chordee, correction was most often approached dorsally. With 50 degrees chordee, 54% approached the problem ventrally. We hope to encourage the use of more objective measurements and terminology. Objective measurements and long-term follow-up will improve our understanding of the natural history of chordee and improve outcomes analysis.

Child↗
PubMed1998

Traumatic renal artery occlusion: a 15-year review.

BACKGROUND: To better define what constitutes appropriate treatment for traumatic renal artery occlusion, we report our 15-year experience in managing this injury. METHODS: A retrospective chart review was performed to evaluate treatment outcomes and complications of 12 patients (13 injuries) who presented to our trauma centers with renal artery occlusion secondary to blunt injury. RESULTS: Five of 12 patients underwent attempted surgical revascularization with a median warm ischemia time of 5 hours (range, 4.5-36 hours). Of these five patients, one required nephrectomy for inability to establish arterial flow, three demonstrated no function, and one had return to 9% differential function on postoperative renal scan. Seven patients did not have attempted revascularization, and none of them experienced immediate complications. Hypertension developed in three patients (43%) who required nephrectomy to control blood pressure at a mean of 5 months after injury (range, 3-7 months). Four patients remained asymptomatic and normotensive at a mean follow-up of 11 months (range, 4 weeks to 2.6 years). CONCLUSION: Surgical revascularization for traumatic renal artery occlusion seldom results in a successful outcome. Patients who are observed must have close follow-up for hypertension.

Adolescent↗
PubMed1991

Crossed renal ectopia without fusion associated with hydronephrosis in an infant.

The incidence of crossed "fused" renal ectopia has been reported at 1 in 7,500 autopsies, an incidence approximately ten times more frequent than crossed renal ectopia without fusion. Most cases remain asymptomatic and are incidentally encountered on autopsy or during routine workup for unrelated disorders. We herein report a case of ureteropelvic junction obstruction secondary to a high ureteral insertion in the pelvis of a crossed unfused ectopic kidney.

Humans↗
PubMed1991

Bladder augmentation in patients with neurogenic bladder and vesicoureteral reflux.

Current treatment of noncompliant neurogenic bladder associated with significant vesicoureteral reflux that is refractory to intermittent self-catheterization and anticholinergic therapy includes bladder augmentation coupled with a procedure to eliminate reflux. Antireflux surgery is often difficult in such a clinical setting. The diseased and thickened detrusor makes reimplantation into the bladder difficult, and successful reimplantation into the intestinal component is tricky and time-consuming. Augmentation alone was done in 14 patients with significant vesicoureteral reflux in the face of a noncompliant, high pressure neurogenic bladder. No effort was made to correct reflux surgically because, in theory, reflux is secondary to abnormal bladder pressure. Of the 13 patients who have had adequate evaluation with postoperative cystograms 12 no longer have reflux. The reflux in the remaining patient has improved from grade IV to grade II. Postoperative cystometric examination in 12 patients demonstrated low pressure and adequate volume. Correction of bladder dynamics alone reversed the reflux. Conversely, persistence of reflux postoperatively is an indication that augmentation has not successfully returned the bladder to a low pressure reservoir. Our experience indicates that antireflux procedures are not routinely needed in this group of patients.

Adolescent↗
PubMed1987

Cecoureterocele.

We report 2 cases of cecoureterocele to emphasize the salient features of this clinical entity. Both patients had a protracted clinical course with repeated episodes of urinary tract infection. A properly performed voiding cystourethrogram demonstrated the problem clearly. Both cases were managed by endoscopic resection of the obstructing tissue. We describe the clinical course, radiological findings and a treatment option for this elusive problem.

Child, Preschool↗
PubMed1986

Spermatic vessel ligation (Fowler-Stephens maneuver): experimental results with regard to fertility.

The effect of unilateral testicular infarction following torsion on contralateral testis spermatogenesis has been studied directly in rats and indirectly in man. Adverse effects on semen quality in humans and on testis biopsy in the experimental animal have been demonstrated. The spermatogenic function of normal contralateral testes following orchiopexy is known to be suboptimal. We studied the effects of transient testis ischemia produced by spermatic vessel ligation (the Fowler-Stephens maneuver) on spermatogenesis in the normal (contralateral) testis in mature Sprague-Dawley rats with spermatogenic activity determined in 10 days. Also, a group of prepubertal rats were operated upon and allowed to reach maturity to determine if prepubertal ischemia would result in any effect on the contralateral testis. Testis injury caused by acute ligation of the total testis blood supply does not cause morphological or spermatogenic changes in the contralateral testis. Ligation of the spermatic vessels may result in varying degrees of testicular injury. Often this injury is much greater histologically than one would expect from gross examination of the testis. However, the effects of this injury on the sperm production in the contralateral testis are negligible in rats and did not result in an iatrogenic decrease in fertility.

Animals↗
PubMed1986

Urethral duplication.

Duplication of the urethra is a rare congenital anomaly. While it is true that in some instances reconstructive surgery is not necessary, those cases that require repair pose a significant challenge to the urologist. Our experience with 3 cases illustrates the potential complexity of this deformity. Two patients presented with significant renal compromise secondary to bladder outlet obstruction and required reconstruction of the entire anterior urethra. The third patient presented with a urethral fistula after circumcision and repair was done by ventral-to-dorsal urethrourethrostomy. A workable classification of duplicated and accessory urethra is outlined. This classification is based on the source of the secondary channel, its point of emptying (that is internal, external or blind) and the relationship of the secondary channel to the normal urethra (that is dorsal or ventral).

Humans↗
PubMed1985

Ultrasound experience with prenatal genitourinary abnormalities.

The ability to diagnose genitourinary abnormalities in the fetus frequently poses management dilemmas for the urologist. Our experience with 13 cases of abnormal fetal ultrasonography examinations thought to be genitourinary in nature underscores difficulties posed by this new technology. In 3 cases the prenatal diagnosis was eventually found to be incorrect. In 1 case, vesicoureteric reflux gave the appearance of hydronephrosis that resolved after birth. In 3 cases in which intervention was deemed necessary, the eventual outcome was unaffected. Prenatal ultrasound is most useful when detecting occult hydronephrosis that would have gone unnoticed in the routine newborn physical examination. However, our patients received no benefit from fetal intervention.

Abnormalities, Multiple↗
PubMed1985

Circumcision: pros and cons.

I have attempted to review the pertinent facts concerning circumcision and the proper care of the foreskin with the express purpose of trying to avoid the errors in technique or the mismanagement of the intact foreskin that occur all too frequently. Until parental and societal attitudes change, it is incumbent upon health care professionals to dispense proper care and provide accurate information regarding the prepuce.

Circumcision, Male↗
PubMed1984

Reflux and voiding abnormalities in children.

Twenty-four patients with vesicoureteral reflux were studied urodynamically because of a history of dysfunctional voiding. Nine patients eventually had antireflux surgery. The remaining 15 patients were followed from two to six years. These patients were managed conservatively with an emphasis on controlling infection and improving voiding habits. Reflux resolved spontaneously in 12 patients and improved in 1 patient. Dysfunctional voiding is a definite cause of childhood reflux. Treatment should be directed at improving voiding patterns. Coordinated voiding may allow a child to "grow out" of his reflux.

Counseling↗
PubMed1984

Distal hypospadias repair.

Since Duckett's introduction of hypospadias repair by meatoplasty and glanuloplasty we have seen a rekindled interest in the correction of the subcoronal hypospadias. However, we have not found this procedure to be widely applicable or the cosmetic results to be universally acceptable. We describe a repair for distal hypospadias that incorporates a more vigorous vertical glans incision plus more aggressive distal urethral mobilization. Reconstruction has been successful in all 28 patients who have undergone this procedure.

Child↗
PubMed1983

Sexuality after urinary undiversion.

We report on the sexuality of 2 young men following urinary undiversion. One patient reported improved sexual experience due to loss of the appliance and improved self-image. Urine leakage during sexual activity can be prevented only by catheterization before intercourse. The other patient has undergone rediversion after a technically satisfactory undiversion because of urine leakage during intercourse that did not respond to intense pharmacologic therapy and bladder emptying before sexual activity. Sexuality following undiversion has not been studied previously. Additional guidelines in preoperative evaluation and patient education are suggested.

Adult↗
PubMed1982

Clinical applications of nuclear cystography.

Nuclear cystography is a sensitive test for detection of vesicoureteral reflux. The value of this sensitivity has not always been appreciated fully. A significant degree of reflux that warrants surgical repair seems readily demonstrable by conventional x-ray methods. Our experience with x-ray and nuclear cystography illustrates the frequent inadequacies of the conventional x-ray study. In 15 of 86 patients reflux of significant clinical degree was demonstrated by the nuclear study alone. This information has proved valuable in the eventual management of these patients.

Adolescent↗