Ahmed A Shokeir

Publications (86)205.72 Total impact

• Article: Systemic and renal haemodynamic changes in renal schemia/reperfusion injury: impact of erythropoietin.

  Abdel-Aziz M Hussein, Nashwa Barakat, Amira Awadalla, Ahmed A Shokeir
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  ABSTRACT: The objective of this study was to investigate the effects of erythropoietin (EPO) on systemic and renal hemodynamics in a rat model of renal ischemic/reperfusion (I/R) injury. We used 30 male Sprague-Dawley rats distributed among the following 3 groups (10 rats per group): (i) the sham-operated group, (ii) the control group (I/R injury only), and (iii) the EPO-treated group (I/R injury with 1500 U EPO·(kg body mass)(-1) on day 0, and 500 U·kg(-1) on days 2 and 4 after ischemia). Renal function, arterial blood pressure (ABP), renal plasma flow (RPF), renal blood flow (RBF), and renal vascular resistance (RVR) were measured on days 1, 2, and 7 after ischemia. The expression of endothelial NO synthase (eNOS) and histopathology of kidney were evaluated on day 7. The contractility of aortic strips was recorded from the different groups. The results show that renal function and histopathology were significantly improved after treatment with EPO. Compared with the control group, the EPO-treated group showed a significant increase in RPF, RBF, haematocrite, ABP, eNOS expression, and a decrease in RVR (p < 0.05).The response of aortic strips to the relaxant effect of acetylcholine was improved in the EPO-treated group. In conclusion, treatment with EPO improves renal function and renal haemodynamics in renal I/R injury, and causes significant rise of ABP and haematocrite value.
  Canadian Journal of Physiology and Pharmacology 11/2012; 90(11):1535-43. · 1.95 Impact Factor
• Article: Reply by the authors.

  Ahmed R El-Nahas, Ibrahim Eraky, Ahmed A Shokeir, Ahmed M Shoma, Ahmed M El-Assmy, Nasr A El-Tabey, Shady Soliman, Ahmed Elshal, Hamdy A El-Kappany, Mahmoud R El-Kenawy
  Urology 10/2012; 80(4):958-9. · 2.43 Impact Factor
• Source

  Available from: Ahmed R El-Nahas

  Article: Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre

  Ahmed R. El-Nahas, Ibrahim Eraky, Ahmed A. Shokeir, Ahmed M. Shoma, Ahmed M. El-Assmy, Nasr A. El-Tabey, Hamdy A. El-Kappany, Mahmoud R. El-Kenawy
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  ABSTRACT: Abstract Objective: To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones. Patients and methods: A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months. Results: Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract (P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts (P = 0.001). Conclusions: PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment
  Arab Journal of Urology. 09/2012; AJU(10):324-329.
• Article: Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone.

  Ahmed R el-Nahas, Ibrahim Eraky, Ahmed A Shokeir, Ahmed M Shoma, Ahmed M el-Assmy, Nasr A el-Tabey, Shady Soliman, Ahmed M Elshal, Hamdy A el-Kappany, Mahmoud R el-Kenawy
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  ABSTRACT: To determine factors affecting the stone-free rate and complications of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. The computerized database of patients who underwent PNL for treatment of staghorn stones between January 2003 and January 2011 was reviewed. All perioperative complications were recorded and classified according to modified Clavien classification system. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free and complication rates. The study included 241 patients (125 male and 116 female) with a mean age of 48.7 ±14.3 years. All patients underwent 251 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 56% (142 procedures). At 3 months, the stone-free rate increased to 73% (183 kidneys) after shock wave lithotripsy. Independent risk factors for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2.2 and 3.1, respectively). The complication rate was 27% (68 PNL). Independent risk factors for development of complications were performance of the procedure by urologists other than experienced endourologist and positive preoperative urine culture (relative risks were 2.2 and 2.1, respectively). Factors affecting the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary calyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if preoperative urine culture is positive.
  Urology 03/2012; 79(6):1236-41. · 2.43 Impact Factor
• Article: Recoverability of renal functions after relief of partial ureteric obstruction of solitary kidney: impact of ferulic acid.

  Ahmed A Shokeir, Abdel-Aziz M Hussein, Shady A Soliman, Mohamed M Kamal, Azza Abdel-Aziz, Amira Awadalla, Mona Abdel Rahim, Nashwa Barakat
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  ABSTRACT: What's known on the subject? and What does the study add? It is known that the kidney damage continues even after release of ureteric obstruction. This study found that giving ferulic acid, antioxidant, after release of ureteric obstruction enhanced the recovery of kidney functions in solitary kidney. To evaluate the effect of ferulic acid (FA) on the recovery of renal function and renal damage after relief of partial ureteric obstruction (PUO) of a solitary kidney. Male mongrel dogs (n = 32) were classified into three groups: sham (eight), control (12) and study (12). A right nephrectomy was carried out and dogs in the study and control groups were subjected to 4 weeks of PUO. Serum creatinine, creatinine clearance (CrCl) and renographic clearance (RC) were measured at baseline, after 4 weeks of obstruction and 8 weeks after relief of obstruction. Markers of lipid peroxidation (malondialdehyde [MDA]), superoxide dismutase (SOD), and reduced glutathione (GSH), and immunostaining of markers of apoptosis (caspase 3 and Bcl2), cell proliferation (Ki67) and interstitial fibrosis in the kidney were evaluated at the end of experiment. Ferulic acid enhanced the recovery of serum creatinine, CrCl and RC by an extra 22%, 26% and 33.7%, respectively, of the basal values at 8 weeks, after relief of 4 weeks' obstruction. In addition, FA caused a significant decrease in MDA and a significant increase in GSH and SOD. Ferulic acid also significantly reduced the interstitial fibrosis, and caspase 3 expression, and significantly increased the expression of Bcl2 and Ki67 in kidney tissues at 8 weeks after relief of the obstruction. Ferulic acid enhances the recoverability of renal function and minimizes the renal damage through reduction of oxidative stress, tubular apoptosis and the interstitial fibrosis in the solitary kidney after relief of PUO.
  BJU International 03/2012; 110(6):904-11. · 2.84 Impact Factor
• Article: Toward a standardized system for reporting surgical outcome of pediatric and adolescent live donor renal allotransplantation.

  Ahmed M Harraz, Ahmed A Shokeir, Shady A Soliman, Ahmed S El-Hefnawy, Mohamed M Kamal, Ahmed I Kamal, Ahmed B Shehab El-Din, Mohamed A Ghoneim
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  ABSTRACT: There is a lack of a standardized reporting methodology for surgical complications of pediatric renal transplantation. We applied Martin criteria and the modified Clavien-Dindo classification in pediatric renal transplantation. We retrospectively reviewed the charts of 447 patients 20 years or younger who underwent renal transplantation between March 1976 and January 2011. Martin criteria were fulfilled and complications were graded according to the modified Clavien-Dindo classification. For early complications grades I and II were considered low grade and III to V high grade. A similar grading system was adopted for late complications. A total of 84 early complications (18.5%) occurred in 77 transplant recipients (17%). Of grade I complications 37 (8.1%) were asymptomatic lymphoceles. Grade II complications were observed in 2 patients (0.4%). Grade IIIa complications included aspiration of hematoma (1 case), percutaneous nephrostomy fixed for ureteral obstruction (3), percutaneous tube drain for symptomatic lymphoceles (7) and antegrade ureteral stenting for ureteral leakage (6). Grade IIIb complications included exploration for wound dehiscence (1 case), revision of ureterovesical anastomosis (8), marsupialization of lymphoceles (4), hemorrhage (3) and vascular thrombotic accidents (6). Graft nephrectomy (grade IVa) complications occurred in 2 transplant recipients. Among 4 mortalities (grade V) only 1 patient died due to surgical complications. On multivariate analysis delayed graft function was the only predicator of high grade surgical complications (p = 0.005). High grade surgical complications affected recipient but not graft survival. Using a standardized, high quality reporting methodology is feasible in pediatric renal transplantation. However, consensus should be sought regarding medical complications and a grading system should be developed for reporting of late complications.
  The Journal of urology 03/2012; 187(3):1041-6. · 4.02 Impact Factor
• Article: Complications of Penile Augmentation by Use of Nonmedical Industrial Silicone.

  Ahmad Shamsodini, Abdulla A Al-Ansari, Raidh A Talib, Haidar M Alkhafaji, Ahmed A Shokeir, Csaba Toth
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  ABSTRACT: Introduction.  Penile augmentation has been reported in the literature by injecting various materials by nonmedical persons. Aim.  This study aims to present our experience in management of penile augmentation complications associated with injection or implantation of industrial silicone by lay persons. Main Outcome Measures.  Early surgical intervention can lead to faster recovery and better cosmetic and functional outcome. Methods.  Two patients had injection of industrial silicone paste, and the other two had industrial silicone ring implantation. All the patients except one were presented after 13 months of the procedure. Patients with industrial silicone ring presented with multiple sinuses of penile skin in one, and abscess discharge pus from the site of implanted ring in the other. Both patients with injected silicone paste presented with swelling and deformity of the penis that interfered with their intercourse. Silicone ring patients underwent skin incision and drainage of the infected materials and extraction of the implants with delayed skin closure. The two patients with silicone paste injection underwent two-stage penile reconstructions using scrotal flap. Results.  Patients with extracted rings had smooth recovery with acceptable cosmetic outcome. One of them was not initially satisfied with the length of his penis that was overcome by short-term use of vacuum device. One of the patients with silicone paste injection had wound infection that was successfully treated with local wound care. Both had satisfactory penile length and acceptable cosmetic outcome. All patients had normal erectile function postoperatively. Conclusion.  Complications of using industrial silicone injection can be drastic, and awareness of the public can avoid using of this material for penile augmentation. Shamsodini A, Al-Ansari AA, Talib RA, Alkhafaji HM, Shokeir AA, and Toth C. Complications of penile augmentation by use of nonmedical industrial silicone. J Sex Med **;**:**-**.
  Journal of Sexual Medicine 12/2011; · 3.55 Impact Factor
• Source

  Available from: Ahmed R El-Nahas

  Article: Percutaneous nephrolithotomy: keeping the bridge for one night.

  Ahmed R El-Nahas, Ahmed A Shokeir
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  ABSTRACT: This study was conducted to compare nephrostomy-free percutaneous nephrolithotomy (PCNL) with early nephrostomy tube removal (after 1 day). A prospective study started from January 2008 through December 2009 and included patients who underwent non-complicated PCNL through a single tract without intra-operative residual stones. Nephrostomy-free technique was performed during 2008 (nephrostomy-free group). During 2009, a nephrostomy tube was placed for 1 day (1-day nephrostomy group). Both groups were compared for post-operative events, dose of analgesia, hemoglobin deficit and hospital stay. The study included 55 patients (27 in nephrostomy-free group and 28 in 1-day nephrostomy group). There were no statistically significant differences between patients, renal and stone characteristics of both groups. Post-operative events were significantly more in nephrostomy-free group (26 vs. 14.3%, p = 0.039). They include hematuria in three (11.1%) of nephrostomy-free patients and one (3.6%) of 1-day nephrostomy patient, severe renal colic in four patients of nephrostomy-free group (14.8%), and temporary urinary leakage via the nephrostomy site in three patients of 1-day nephrostomy group (10.7%). Mean dose of post-operative analgesia, mean hemoglobin deficit and hospital days were comparable for both groups (p = 0.946, 0.541, 0.807, respectively). A second look PCNL was performed through the already present tract to retrieve residual stones in two patients with nephrostomy. In conclusion, 1-day nephrostomy technique after PCNL showed significantly better post-operative course. It was comparable to nephrostomy-free technique in analgesic requirements and hospital stay. The nephrostomy tube provided a bridge for second look nephroscopy.
  Urological Research 11/2011; 40(4):389-93. · 1.23 Impact Factor
• Chapter: Difficulties in Laparoscopic Simple Nephrectomy

  Ahmed M. Harraz, Ahmed R. El-Nahas, Ahmed A. Shokeir
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  ABSTRACT: The first transperitoneal laparoscopic nephrectomy was performed by Clayman et al. in 1990.1 Since then, this surgery has been performed for various benign renal diseases. In 1992, Gaur et al. developed the balloon dissection technique for creation of the retroperitoneal space.2 Since that time, retroperitoneoscopic nephrectomy has been demonstrated to be safe and effective for benign nonfunctioning kidneys.3,4 Refinements such as entrapment bags and tissue morcellators have improved both the efficiency of specimen removal and the minimally invasive nature of the procedure. Laparoscopic nephrectomy offers less postoperative pain, shorter hospital stay and convalescence, and an optimal cosmetic result compared with traditional open surgery.5,6
  08/2011: pages 55-70;
• Article: Role of combination of L-arginine and α-tocopherol in renal transplantation ischaemia/reperfusion injury: a randomized controlled experimental study in a rat model.

  Ahmed A Shokeir, Nashwa Barakat, Abdel-Aziz M Hussein, Amira Awadalla, Azza Abdel-Aziz, Hassan Abo-Elenin
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  ABSTRACT: What's known on the subject? and What does the study add? Renal ischaemia/reperfusion (I/R) injury is an inevitable consequence of kidney transplantation. It contributes to delayed graft function (DGF), acute renal failure and graft rejection. The present study investigates for the first time the impact of a combination of L-arginine and alpha tocopherol on the renal ischemia/reperfusion injury in a rodent model of kidney transplantation. We found that concomitant administration of L-arginine and α-tocopherol has a more protective effect and synergistic antioxidant effect on ischaemia/reperfusion injury in transplanted rat kidneys. To investigate the role of L-arginine and α-tocopherol in ischaemia/reperfusion injury in a kidney transplanted rat model. In total, 40 male Sprague-Dawley rats subjected to renal transplantation received FK506 (tacrolimus) to overcome early acute rejection episodes. Animals were divided randomly into four groups (ten rats each). Group I were treated with FK506 (2 mg/kg/bw/day) and served as the control group. Group II were treated with L-arginine 300 mg/kg/bw. Group III were treated with α-tocopherol 30 mg/kg/bw. Group IV were treated with L-arginine and α-tocopherol. Urine and blood samples were taken at 0 (before operation), 2, 7 and 14 days post-transplantation for estimation of urine sodium, creatinine, fractional excretion of sodium, serum creatinine, sodium and blood urea nitrogen. Histological examination and measurement of malondialdehyde in kidney tissues were also performed. Serum creatinine and blood urea nitrogen significantly decreased in L-arginine and α-tocopherol, as well as combination groups, compared to the control group. Malondialdehyde was significantly decreased in the combination group compared to L-arginine and α-tocopherol alone. Histological examination of the control group showed that acute tubular necrosis was markedly decreased in transplanted kidneys treated with a combination of both L-arginine and α-tocopherol. Concomitant administration of l-arginine and α-tocopherol has a more protective effect and synergistic antioxidant effect on ischaemia/reperfusion injury in transplanted rat kidneys.
  BJU International 05/2011; 108(4):612-8. · 2.84 Impact Factor
• Source

  Available from: Ayman Refaie

  Article: Steroid avoidance reduce the cost of morbidities after live-donor renal allotransplants: a prospective, randomized, controlled study.

  Osama A Gheith, Ahmed H Nematalla, Mohamed A Bakr, Ayman Refaie, Ahmed A Shokeir, Mohamed A Ghoneim
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  ABSTRACT: Steroids have had the main role in renal transplant for more than 4 decades. However, chronic use of steroids is associated with many comorbidities, owing to a lack of assessing cost-benefit of steroid avoidance in live-donor renal allotransplants. In this prospective, randomized, controlled study, we aimed to assess the cost-benefit of a steroid-free immunosuppression regimen among Egyptian live-donor renal transplants. One hundred patients were randomly allocated to receive tacrolimus, mycophenolate mofetil, and steroids for only 3 days (n=50 patients; study group) or tacrolimus, mycophenolate mofetil, and steroids on a maintenance basis (n=50 patients; control group). All patients received basiliximab (Simulect) induction, with median follow-up of 12 months. Both groups showed comparable graft and patient survivals, rejection episodes, and graft functioning. Posttransplant comorbidities were significantly more prevalent in the steroid-maintenance group. Hypertension was detected in 4% of steroid-free group versus 24% in the steroid-maintenance group (P = .0009). Posttransplant diabetes mellitus, serious infections, and hyperlipidemia were significantly more prevalent in the steroid-maintenance group (P < .05). Associated hospitalization costs were 2.2-fold higher in the steroid-maintenance group than they were in the steroid-free group. One year after transplant, the cost of managing posttransplant comorbidities was significantly higher in steroid-maintenance group, despite comparable costs of immunosuppression. In low, immunologic risk recipients of live-donor renal transplants, using basiliximab induction and maintenance with tacrolimus, mycophenolate mofetil, steroid avoidance was associated with lower first annual total costs despite comparable immunosuppression costs, which was attributed to lower costs of associated morbidities.
  Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 04/2011; 9(2):121-7.
• Article: Percutaneous nephrolithotomy: critical analysis of unfavorable results.

  Abdulkader Alobaidy, Abdulla Al-Naimi, Khalid Assadiq, Haidar Alkhafaji, Abdulla Al-Ansari, Ahmed A Shokeir
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  ABSTRACT: To identify the risk factors of unfavorable results of percutaneous nephrolithotomy (PCNL). A total of 602 patients were subjected to 616 PCNL procedures. Patients were divided into two groups according to the results of treatment. Group 1 with favorable results includes patients who became stone free after a single PCNL procedure without major complications. Group 2 with unfavorable results includes three subgroups: a) Patients who developed major complications, b) Those who required second major intervention to complete stone removal, and c) Patients with residual stones > 4 mm at 3 month. Risk factors for unfavorable outcome were studied by univariate and multivariate analyses. Unfavorable results were documented in 176 patients (28.6%) due to major complications in 40 (6.5%), need for second intervention in 124 (20%), and presence of residual stones > 4 mm at 3 month in 12 (1.9%). The remaining 440 patients (71.4%) were considered of favorable outcome. Independent risk factors of unfavorable results on multivariate analysis were staghorn stones, multiple stones and stone largest diameter > 50 mm. To optimize the results of PCNL, urologists should consider careful patient selection. Patients with staghorn stones, multiple stones or large stone burden are more susceptible to unfavorable outcome.
  The Canadian Journal of Urology 02/2011; 18(1):5542-7. · 0.64 Impact Factor
• Source

  Available from: Ayman Refaie

  Article: Hyperechogenic renal parenchyma in potential live related kidney donors: Does it justify exclusion?

  Mohamed A. Fouda, Ahmed A. Shokeir, Ehab W. Wafa, Ayman F. Refaie, Tarek El Diasty, Mona Abdelrahim, Mohamed A. Sobh, Mohamed A. Ghoneim
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  ABSTRACT: Abstract Objectives To assess the predictive importance of ultrasonic grade 1 hyperechogenicity in potential live related kidney donors in the absence of urinary abnormalities and with perfect renal function. Subjects and methods The study included 34 potential living related kidney donors with this abnormality; their mean (SD, range) age was 32.7 (8.45, 23–48) years. Ten matched healthy donors with normal ultrasonographic appearance of the kidneys were studied as controls. All cases were thoroughly investigated, including measuring glomerular filtration rate by isotopic scintigraphy. The renal reserve was estimated by dopamine and amino-acid infusion in all subjects (study and control groups). A percutaneous renal biopsy was taken from 17 subjects in the abnormal echogenicity group and open renal biopsy was taken from eight of the control subjects. Results The renal reserve was comparable in both groups. Abnormal histopathological changes were found in seven subjects (41%) of the abnormal echogenicity group, i.e. partial glomerulosclerosis in one, mesangial thickening in two, interstitial fibrosis in one, focal tubular atrophy in one, immunoglobulin (Ig M) immune deposits in three and IgA in one. Only one subject in the control group showed mild mesangial thickening. Conclusion Grade 1 echogenicity might be a sign of unrecognized kidney disease. Renal biopsy is mandatory when such related donors are the only available ones. Abnormal histopathology contraindicates donation.
  Arab Journal of Urology. 01/2011; 9(4):235-239.
• Article: Endourological treatment of nonmalignant upper urinary tract complications after urinary diversion.

  Ahmed R El-Nahas, Ahmed A Shokeir
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  ABSTRACT: Endourological modalities are considered the first line of treatment for benign ureterointestinal anastomotic strictures except in long strictures, completely obliterated lumen, prior radiation, and poor renal function. Endoureterotomy provided better success than balloon dilatation. In poor-operative risk patients, metal or double-J stents are viable options. Endourological treatments of upper tract stones after diversion are indicated for stones not suitable for shock wave lithotripsy (SWL) or to salvage SWL failure. Percutaneous nephrolithotomy was preferred for large or complex renal stones, whereas ureteroscopy was used for smaller stones. The evaluation of stone-free status and regular follow-up are mandatory because of the high recurrence rate.
  Urology 12/2010; 76(6):1302-8. · 2.43 Impact Factor
• Article: Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones.

  Ahmed R El-Nahas, Ibrahim Eraky, Ahmed A Shokeir, Ahmed M Shoma, Ahmed M El-Assmy, Nasr A El-Tabey, Hamdy A El-Kappany, Mahmoud R El-Kenawy
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  ABSTRACT: • To study long-term results of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. • The records of patients who underwent PNL for staghorn stones between January 1998 and January 2008 were retrospectively reviewed. • Patients who completed follow-up for one year or more were included. Follow-up with KUB and renal ultrasonography were performed every 3-6 months. • Renal radioisotopic scan was performed for patients who had already undergone this study before doing PNL. • The study included 122 patients (69 male and 53 female) with mean age 47.6 ± 14.5 years (5-74). They underwent 126 PNL. • Perioperative complications were encountered in 28 procedures (22%). The mean period of follow-up was 3.5 ± 2.3 years (1-11.3). Among 71 stone-free kidneys, 18 (25%) developed stone recurrence. Of 55 kidneys with residuals at the start of follow-up, 36 (65%) showed growth of these residuals. • Preoperative and postoperative renograms were performed for 71 patients. • At the last follow-up, differential GFR was stable in 53 (74.5%), improved in 12 (17%) and deteriorated in 6 (8.5%). Among patients with deteriorated renal function, 3 had undergone embolization to control severe bleeding, one developed secondary UPJO, and one had recurrent stone obstructing the kidney. • Long-term functional results of PNL for staghorn stones are satisfactory as 91.5% of kidneys showed stable or improved GFR. Long-term follow-up is mandatory especially for patients with residual stones.
  BJU International 12/2010; 108(5):750-4. · 2.84 Impact Factor
• Article: Tissue engineering and stem cells: basic principles and applications in urology.

  Ahmed A Shokeir, Ahmed M Harraz, Ahmed B Shehab El-Din
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  ABSTRACT: To overcome problems of damaged urinary tract tissues and complications of current procedures, tissue engineering (TE) techniques and stem cell (SC) research have achieved great progress. Although diversity of techniques is used, urologists should know the basics. We carried out a literature review regarding the basic principles and applications of TE and SC technologies in the genitourinary tract. We carried out MEDLINE/PubMed searches for English articles until March 2010 using a combination of the following keywords: bladder, erectile dysfunction, kidney, prostate, Peyronie's disease, stem cells, stress urinary incontinence, testis, tissue engineering, ureter, urethra and urinary tract. Retrieved abstracts were checked, and full versions of relevant articles were obtained. Scientists have achieved great advances in basic science research. This is obvious by the tremendous increase in the number of publications. We divided this review in two topics; the first discusses basic science principles of TE and SC, whereas the second part delineates current clinical applications and advances in urological literature. TE and SC applications represent an alternative resource for treating complicated urological diseases. Despite the paucity of clinical trials, the promising results of animal models and continuous work represents the hope of treating various urological disorders with this technology.
  International Journal of Urology 10/2010; 17(12):964-73. · 1.75 Impact Factor
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  Available from: eu-acme.org

  Article: GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up.

  Abdulla Al-Ansari, Nagy Younes, Venkataramana Pai Sampige, Khalid Al-Rumaihi, Ardalan Ghafouri, Tawiz Gul, Ahmed A Shokeir
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  ABSTRACT: Photoselective vaporization (PVP) with the GreenLight HPS 120-W laser (GLL) was recently introduced for treatment of benign prostatic hyperplasia (BPH). To compare results of GLL PVP and transurethral resection of the prostate (TURP) for treatment of BPH. A total of 120 patients with BPH were randomly assigned to two equal groups: TURP or PVP. Both groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Q(max)), and postvoid residual (PVR) urine were assessed at 1, 3, 6, 12, 24, and 36 mo. A total of 55 and 54 patients completed 36 mo of follow-up in the TURP and PVP groups, respectively. Baseline characteristics were comparable. Mean operative time was significantly shorter for TURP. Compared to preoperative values, there was significant reduction in hemoglobin and serum sodium levels at the end of TURP only. A significant difference in favor of PVP was achieved regarding the duration of catheterization and hospital stay. In the PVP, no major intraoperative complications were recorded and none of the patients required blood transfusion. Among TURP patients, 12 (20%) required transfusion, 3 (5%) developed TUR syndrome, and capsule perforation was observed in 10 patients. There was dramatic improvement in Q(max), IPSS, and PVP compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up. Storage bladder symptoms were significantly higher in PVP. By the end of 36 mo, five patients in TURP and six in PVP were lost to follow-up. A redo procedure was required in one TURP patient and six PVP patients (p<0.05). Two TURP patients and four PVP patients developed bladder neck contracture (p>0.05) treated by bladder neck incision; none in either group experienced urethral stricture or urinary incontinence. Compared with TURP, 120-W GLL PVP is safe and effective in treatment of BPH.
  European urology 09/2010; 58(3):349-55. · 7.67 Impact Factor
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  Available from: Ayman Refaie

  Article: Cost-benefit of steroid avoidance in renal transplant patients: a prospective randomized study.

  Osama A Gheith, Ahmed H Nematalla, Mohamed A Bakr, Ayman Refaie, Ahmed A Shokeir, Mohamed A Ghoneim
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  ABSTRACT: Steroids have played a major role in renal transplantation for more than four decades. However, chronic use of steroids is associated with a lot of comorbidities. This study aimed to assess the cost-benefit of steroid-free immunosuppression regimen in a prospective randomized controlled study of live donor renal transplantation, which was lacking in the literature. One-hundred patients were randomized to receive tacrolimus (Tac), mycophenolate mofetil (MMF), basiliximab (Simulect) induction and steroids only for 3 days (50 patients, study group) or Tac, MMF, Simulect induction and steroid maintenance (50 patients, control group). Median follow-up was 12 months. Both groups showed comparable graft and patient survival, rejection episodes and graft function. Post-transplant hypertension was detected in 4% of the steroid-free group and 24% of the steroid maintenance group (p = 0.0009), while post-transplant diabetes mellitus was detected in 4% and 16% of these two groups, respectively (p = 0.037). By the end of the first year, the cost of managing post-transplant morbidities was significantly higher in the steroid maintenance group, despite the comparable cost of immunosuppression. Among low immunological risk recipients of live donor renal transplants, steroid avoidance was feasible, safe and with less morbidity, using Simulect induction, and tacrolimus and MMF as maintenance immunosuppression. Steroid avoidance was associated with a lower total cost despite comparable immunosuppression cost, which was attributed to the lower cost of associated morbidities.
  Scandinavian Journal of Urology and Nephrology 03/2010; 44(3):175-82. · 0.99 Impact Factor
• Article: Effects of combined erythropoietin and epidermal growth factor on renal ischaemia/reperfusion injury: a randomized experimental controlled study.

  Abd El-Aziz M Hussein, Ahmed A Shokeir, Mohammed E Sarhan, Fayza R El-Menabawy, Hanaa A Abd-Elmoneim, Eman M El-Nashar, Nashwa M Barakat
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  ABSTRACT: To investigate effects of combination of erythropoietin (EPO) and epidermal growth factor (EGF) on renal ischaemia and on reactive oxygen species in a rat model. In all, 90 male Sprague-Dawley rats were allocated into five groups of 18, designated: Sham; treated with right nephrectomy only; Control, subjected to left renal ischaemia for 45 min with no treatment; EPO-treated, as the control but with EPO pretreatment; EGF-treated, as the control but with EGF pretreatment; EPO + EGF-treated, as the control but with EPO and EGF pretreatment. Renal function, histopathology and malondialdehyde (MDA), superoxide dismutase (SOD) and reduced glutathione (GSH) levels in kidneys were assessed at 1, 2 and 7 days after ischaemia. All rats except the controls had a significant improvement in serum creatinine, creatinine clearance and fractional excretion of Na(+) ; all three were significantly better in EPO + EGF group than in all other groups Histopathological examination showed marked structural damage in control rats. The tubular damage was least in the EPO + EGF group. The control group had a significant increase in MDA level and a significant decrease in SOD and GSH, while the EPO + EGF group had a marked significant reduction in MDA and increase in GSH and SOD. The protection against ischaemia/reperfusion injury might be maximal when EPO and EGF are administered concomitantly, and their protective effect might be partly due to their antioxidant effects.
  BJU International 03/2010; 107(2):323-8. · 2.84 Impact Factor
• Article: Bladder Stone: A Complication of Intravesical Migration of Lippes LoopCase Report

  Tarek A. El-Diasty, Ahmed A. Shokeir, Mohamed S. El-Gharib, Lotfy S. Sherif, Mostafa A. Shamaa
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  ABSTRACT: We report on a woman in whom an intrauterine contraceptive device (Lippes loop) migrated from the uterus to the bladder with formation of a calculus. Eight years elapsed between intrauterine insertion of the device and its retrieval with the calculus from the bladder.
  02/2010; 27(2):279-280.