A A Sidi

Minneapolis Veterans Affairs Hospital, Minneapolis, Minnesota, United States

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Publications (36)139.31 Total impact

  • G. Zhang · D. Kappor · A. Sidi ·
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    ABSTRACT: Interstitial cystitis represents a diagnostic and therapeutic challenge. Most patients can be managed conservatively, but a small number of patients do not respond to conservative therapy and for them surgical treatment is indicated. This article reviews the historical and currently used surgical modalities. Enterocystoplasty is the surgical treatment of choice for intractable interstitial cystitis. The results of enterocystoplasty are satisfactory in approximately 80% of patients. However, no histological findings, such as mast cell density or degree of inflammation, can be used as a preoperative predictor of treatment results. The best results of cystoplasty seem to be achieved in patients who have a small bladder capacity, determined preoperatively under anesthesia. Approximately 10%–20% of patients may not be able to void spontaneously after surgery and require self-catheterization. Because of the unpredictable results, cystoplasty must be recommended with caution for certain patients. There is no evidence to indicate that a supratrigonal cystectomy and substitution cystoplasty offer a therapeutic advantage over augmentation cystoplasty alone. The choice of bowel segment does not affect the final outcome provided that it is tubularized and made spherical in configuration.
    International Urogynecology Journal 06/1992; 3(2):155-162. DOI:10.1007/BF00455098 · 1.96 Impact Factor
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    ABSTRACT: The subject of transurethral resection of the prostate (TURP) after renal transplantation has not been evaluated in the urologic literature. We retrospectively compared the outcome of renal transplantation in 8 patients who underwent transurethral resection of the prostate within ten days of renal transplantation with 8 patients who did not undergo prostate surgery. Patients were computer-matched for seven parameters. There was no statistically significant difference in patient survival (6 vs 7) and graft survival (56% vs 88%) between the two groups. However, there was a 25 percent incidence of major perioperative complications (including one mortality) in the TURP group directly attributable to the procedure. Transurethral resection of the prostate can be safely performed immediately after renal transplantation only if urine is sterile, antibiotics and steroids are carefully administered perioperatively, low-gravity irrigation is used, and hemostasis is meticulous.
    Urology 05/1992; 39(4):319-21. DOI:10.1016/0090-4295(92)90205-B · 2.19 Impact Factor
  • E. F. Becher · G. K. Zhang · A. A. Sidi ·
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    ABSTRACT: Urinary incontinence resulting from impaired bladder storage abilities, which is unresponsive to conservative treatments, presents a therapeutic challenge. Carefully selected patients with neurogenic bladder dysfunction, a structurally or anatomically smallcapacity bladder, idiopathic bladder instability, and interstitial cystitis may benefit from augmentation enterocystoplasty. The preoperative evaluation should include a complete assessment of the urinary tract, renal function, and the continence mechanism, along with a careful assessment of urethral accessibility and patency and the patient's willingness and ability to perform lifelong intermittent self-catheterization. Although any segment of bowel is suitable for bladder augmentation, it is advisable to avoid the ileocecal segment in patients with neurogenic bladder dysfunction. The bowel segment should be detubularized and anastomosed to the widely spatulated bladder to avoid an hour-glass deformity. In the immediate postoperative period, patency of the catheter is maintained by frequent, gentle irrigations. Long-term follow-up is mandatory to monitor the chronic bacteriuria and because of the low incidence of spontaneous bladder perforation and carcinogenesis in the augmented bladder.Augmentation enterocystoplasty is an effective treatment for urinary storage problems. It increases the functional and anatomical capacity of the bladder, decreases intravesical pressure, and protects the upper urinary tract.
    International Urogynecology Journal 01/1992; 3(1):43-49. DOI:10.1007/BF00372651 · 1.96 Impact Factor
  • J H Lewis · A A Sidi · P K Reddy ·

    Contemporary urology 01/1992; 3(12):15; 19-21; 24.
  • G Zhang · N F Wasserman · A A Sidi · Y Reinberg · P K Reddy ·
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    ABSTRACT: A total of 132 patients with stage A1 adenocarcinoma of the prostate was followed for 5 to 23 years (mean 8.2 years). Of these patients 52 underwent a second staging transurethral resection of the prostate between 1977 and 1986. Progressive disease developed in 3 of the 12 patients (25%) in whom residual foci of well differentiated cancer were detected by the second transurethral resection and who did not undergo further treatment. Of the 38 patients in whom the second transurethral resection did not detect residual cancer 3 (8%) also had progressive disease. From April 1989 to December 1989, 44 patients were re-evaluated by transrectal ultrasonography and ultrasonographically guided biopsies. Of these patients 3 had locally progressive disease. Progressive disease also developed in 4 more patients. Thus, 13 of the 132 patients (10%) had either locally or systemically progressive disease after long-term followup. The interval from diagnosis of stage A1 disease to detection of progression ranged from 6 months to 20 years (mean 7 years). Ten patients underwent definitive treatment for what was believed to be locally progressive disease, 2 underwent palliative therapy and 1 had no therapy due to poor physical condition. Of the 10 patients who underwent definitive therapy 6 are alive without evidence of disease, 2 died of unrelated causes without evidence of disease and 2 are alive with stage D1 disease. These data suggest that patients in whom a second staging transurethral resection of the prostate detects residual cancer have a high probability of progressive disease. Also, negative findings from a second staging transurethral resection may not exclude the possibility of disease progression. Expectant management of stage A1 disease is warranted but regular and long-term followup is mandatory.
    The Journal of Urology 08/1991; 146(1):99-102; discussion 102-3. · 4.47 Impact Factor
  • A A Sidi · E F Becher · G Zhang · J H Lewis ·
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    ABSTRACT: Patient acceptance of and satisfaction with an external negative pressure device as a treatment for impotence were retrospectively analyzed among 100 men. The over-all satisfaction rate was 68%. Reasons for dissatisfaction with and discontinuing the use of the device included premature loss of penile tumescence and rigidity, pain or discomfort either during application of suction or during intercourse and inconvenience. Negative pressure therapy is an effective treatment for impotence of various etiologies and should be among treatment options offered to the impotent patient.
    The Journal of Urology 12/1990; 144(5):1154-6. · 4.47 Impact Factor
  • P K Reddy · A A Sidi · P H Lange ·
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    ABSTRACT: The modified dorsal lithotomy position is excellent for radical pelvic operations. Use of modified Krauss arm supports as stirrups, along with pneumatic devices that intermittently compress the legs, significantly reduces postoperative morbidity in patients who undergo operations in this position.
    Urologic Clinics of North America 03/1990; 17(1):131-3. · 1.20 Impact Factor
  • A A Sidi · P K Reddy ·
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    ABSTRACT: A simplified tourniquet, the Barretta Laso, is described for use during intracavernous injection of vasoactive drugs. The advantages of this device over current tourniquet methods include simple application; easy control of the degree of constriction; and quick, single-handed release.
    Urologic Clinics of North America 03/1990; 17(1):19-21. · 1.20 Impact Factor
  • P K Reddy · A A Sidi ·
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    ABSTRACT: Endoscopic ureteral occlusion and nephrostomy drainage is a simple, nonsurgical procedure that can control urine leakage from an intractable lower urinary tract fistula and improve the quality of life for a patient with a short life expectancy.
    Urologic Clinics of North America 03/1990; 17(1):103-5. · 1.20 Impact Factor
  • D D Dykstra · A A Sidi ·
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    ABSTRACT: The ability of botulinum A toxin to denervate and relax a spastic external urethral sphincter was evaluated in a double-blind study involving five men with high spinal cord injuries and detrusor-sphincter dyssynergia. The sphincter was injected with either a low dose of botulinum A toxin or normal saline once per week for three weeks. Electromyography of the external urethral sphincter indicated denervation in the three patients who received toxin injections. The urethral pressure profile decreased an average of 25cm of water, postvoiding residual volume of urine decreased an average of 125cc, and bladder pressure during voiding decreased to an average of 30cm of water. Bulbosphincteric reflexes were more difficult to obtain, and they showed a decreased amplitude with normal latency. In the two patients who received normal saline injections, parameters were unchanged from baseline values until subsequent injection with botulinum A toxin once per week for three weeks when their responses were similar to those of the other three patients. Mild generalized weakness lasting two to three weeks was noted by three patients after initial toxin injections. The duration of the toxin's effect averaged two months. The results suggest that botulinum A toxin, an inhibitor of acetylcholine release at the neuromuscular junction, may be useful in the treatment of detrusor-sphincter dyssynergia.
    Archives of Physical Medicine and Rehabilitation 02/1990; 71(1):24-6. · 2.57 Impact Factor
  • A A Sidi · E F Becher · P K Reddy · D D Dykstra ·
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    ABSTRACT: A total of 12 spinal cord injury adults underwent augmentation enterocystoplasty for treatment of a high pressure neurogenic bladder. These patients suffered from urinary incontinence, recurrent urinary tract infection, upper tract deterioration and severe autonomic dysreflexia. A sigmoid colon segment fashioned into a cup-patch was used in 11 patients and detubularized cecum was used in 1. The artificial urinary sphincter was implanted in 3 patients at augmentation enterocystoplasty and in 1 after enterocystoplasty. After a mean followup of 15 months all patients were continent on clean intermittent self-catheterization, the upper tract had remained stable or had improved and the symptoms of autonomic dysreflexia had disappeared. A third of the patients are on maintenance antibiotic therapy to control bacteriuria.
    The Journal of Urology 02/1990; 143(1):83-5. · 4.47 Impact Factor
  • N Koleilat · A A Sidi · R Gonzalez ·
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    ABSTRACT: Intermittent catheterization is used commonly to treat bladder dysfunction. We treated 10 patients who were experiencing difficulty with intermittent catheterization, 9 of whom had a false urethral passage. Of these patients 6 had previously undergone a bladder neck or urethral operation. Endoscopy was helpful to diagnose the condition. Treatment consisted of stenting in 3 patients, transurethral incision and stenting in 3, and fulguration and stenting in 4. An indwelling catheter was left in place for 2 to 3 weeks, after which intermittent catheterization was resumed with a softer catheter. Two patients again experienced severe difficulty with catheterization and they underwent a continent urinary diversion. When intermittent catheterization becomes difficult or impossible, the presence of a urethral false passage should be suspected as a possible cause.
    The Journal of Urology 12/1989; 142(5):1216-7. · 4.47 Impact Factor
  • Edgardo Becher · Abraham Sidi ·

    Seminars in Interventional Radiology 12/1989; 6(04):231-234. DOI:10.1055/s-2008-1075921
  • R Gonzalez · N Koleilat · C Austin · A A Sidi ·
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    ABSTRACT: The artificial urinary sphincter AS800 was implanted in 33 male and 13 female patients with congenital urinary tract incontinence. In 15 patients (32 per cent) previous operations to correct incontinence had failed. The sphincter was implanted around the bladder neck in 43 patients and around the bulbous urethra in 3. Mean patient age at the time of sphincter implantation was 13 years. In 40 patients (87 per cent) the sphincter functions well after a mean followup of 25 months and 39 patients (85 per cent) have satisfactory continence. In 6 patients the sphincter was removed because urethral, vulvar or scrotal erosions developed, all of whom had had previous surgical procedures in the area of the erosion. In 1 patient not operated upon previously erosion of the bulbous urethra developed. He did well after a new sphincter was implanted around the bladder neck. Five patients required an enterocystoplasty to achieve continence following the sphincter implantation. Nine patients required surgical revision of the sphincter for mechanical failure, technical errors, trauma and patient growth. We conclude that in patients with neurogenic sphincter failure implantation of an artificial sphincter around the bladder neck should be considered as the initial treatment of choice.
    The Journal of Urology 09/1989; 142(2 Pt 2):512-5; discussion 520-1. · 4.47 Impact Factor
  • R Gonzalez · D H Nguyen · N Koleilat · A A Sidi ·
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    ABSTRACT: Placement of the artificial urinary sphincter during augmentation enterocystoplasty may lead to infection, erosion and eventual removal of the device. To assess compatibility of artificial urinary sphincter implantation and enterocystoplasty we reviewed the records of 30 patients who had undergone enterocystoplasty and artificial urinary sphincter placement simultaneously (11), enterocystoplasty before artificial urinary sphincter placement (12) and artificial urinary sphincter placement before enterocystoplasty (7). The 19 male and 11 female patients were between 4 and 42 years old (median age 13.5 years). Followup in 28 patients ranged from 6 months to 8 years (average 17 months). Incontinence resulted from myelodysplasia in 16 patients, sacral agenesis in 3, spinal cord injury in 6, posterior urethral valves in 1, bilateral ectopic ureters in 1 and epispadias-exstrophy in 3. Erosion occurred in 2 patients (7 per cent): 1 female patient who underwent simultaneous sphincter implantation and enterocystoplasty and who had undergone previously many bladder neck reconstructive procedures, including polytetrafluoroethylene (Teflon) injection, and 1 female patient in whom the augmented bladder was entered at artificial urinary sphincter implantation. Mechanical failure occurred 4 times in 3 patients and the artificial urinary sphincter was improperly placed in 1. Over-all continence rate was 87 per cent (26 of 30 patients). Simultaneous placement of the artificial urinary sphincter and enterocystoplasty did not seem to affect the outcome of sphincter implantation if good bowel preparation, intravenous antibiotics and sterility of urine were accomplished preoperatively. Entering the augmented bladder during sphincter implantation may predispose to infection and erosion.
    The Journal of Urology 09/1989; 142(2 Pt 2):502-4; discussion 520-1. · 4.47 Impact Factor
  • Edgardo Becher · Abraham Sidi ·

    Seminars in Interventional Radiology 03/1989; 6(01):22-27. DOI:10.1055/s-2008-1075889
  • A A Sidi · P K Reddy · K K Chen ·
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    ABSTRACT: Patient acceptance of and satisfaction with a trial of vasoactive intracavernous pharmacotherapy for impotence among 372 men were retrospectively analyzed. Drop out from the dosage determination phase and the training for injection phase was similar, 9.7 and 8.4 per cent, respectively, while 31.4 per cent of the patients dropped out of the home injection phase. Tachyphylaxis, inconvenience of the procedure or the frequent followup visits required, side effects and concern about unknown long-term effects were the main reasons patients cited for dropping out of the trial. The degree of satisfaction among patients who entered the home injection phase was high. Only 55 patients who dropped out of the trial chose implantation of a penile prosthesis. Vasoactive intracavernous pharmacotherapy is an effective treatment for impotence of various etiologies, and in a carefully selected group of patients the acceptance of and satisfaction with this therapy are high.
    The Journal of Urology 09/1988; 140(2):293-4. · 4.47 Impact Factor
  • A A Sidi · D D Dykstra · W Peng ·
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    ABSTRACT: A total of 57 patients with neuropathic or nonneuropathic detrusor areflexia was studied with the bethanechol supersensitivity test, electromyography of the urethral rhabdosphincter and bulbocavernosus reflex latency. The sensitivity of these tests in detecting neuropathic areflexia was 90, 87.5 and 78.1 per cent, respectively, and the specificity was 95.6, 76 and 80 per cent, respectively. When all 3 tests were performed together the combined accuracy approached 100 per cent. These combined tests are useful in the diagnosis of patients with equivocal bladder neuropathic conditions and in those with subtle neurological lesions.
    The Journal of Urology 09/1988; 140(2):335-7. · 4.47 Impact Factor
  • D D Dykstra · AA Sidi · AB Scott · J M Pagel · G D Goldish ·
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    ABSTRACT: We evaluated the ability of low doses of botulinum A toxin, an inhibitor of acetylcholine release at the neuromuscular junction, to denervate and relax the spastic rhabdosphincter in 11 men with spinal cord injury and detrusor-sphincter dyssynergia. Toxin concentration, injection volume, percutaneous versus cystoscopic injection of the sphincter and number of injections were evaluated in 3 treatment protocols. All 10 patients evaluated by electromyography after injection showed signs of sphincter denervation. Bulbosphincteric reflexes in the 10 patients evaluated after injection were more difficult to obtain, and they showed a decreased amplitude and normal latency. The urethral pressure profile in the 7 patients in whom it was measured before and after treatment decreased an average of 27 cm. water after toxin injections. Post-void residual urine volume decreased by an average of 146 cc after the toxin injections in 8 patients. In the 8 patients for whom it could be determined toxin effects lasted an average of 50 days. The toxin also decreased autonomic dysreflexia in 5 patients.
    The Journal of Urology 06/1988; 139(5):919-22. · 4.47 Impact Factor
  • H Aliabadi · A Ami Sidi · R Gonzalez ·
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    ABSTRACT: From June 1980 to October 1985 we performed 22 ureteropyeloplasties on 20 infants and neonates with ureteropelvic junction obstruction. All patients were males less than 2 years old; 12 were less than 1-month-old. The diagnosis was suspected on the basis of maternal ultrasonography in 10 patients (50%), a palpable abdominal mass was the presenting symptom in 7 (35%), and obstruction was detected during evaluation of congenital heart disease in 3 (15%). This change in mode of presentation is expected to become even more pronounced as the use of fetal ultrasonography increases. All patients in whom the diagnosis was suspected antenatally underwent ultrasonography after birth to confirm the presence of hydronephrosis. All 22 obstructed kidneys were repaired by a dismembered technique under optical magnification. There were no operative mortalities. Of 21 postoperative intravenous pyelograms available, 3 demonstrated marked improvement, 17 showed improvement with residual hydronephrosis, and 1 showed deterioration. The methods used to diagnose, treat and evaluate ureteropelvic junction obstruction in 20 infants and neonates are presented. Given the existing clinical and experimental data we advocate early postnatal surgical correction of ureteropelvic junction obstruction to achieve a maximum recovery of renal function.
    European Urology 02/1988; 15(1-2):103-7. · 13.94 Impact Factor