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Publications (3)5.07 Total impact

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    ABSTRACT: Complete urethral duplication is a rare congenital genitourinary anomaly with various symptoms. Since anatomical place of urethra greatly varies between cases, surgical management of the patients is personalized according to the type of the duplication and requires a careful workup before planning for any intervention. In this case report, a 4-year-old boy with finding of complete proximal hypospadiac urethral duplication is presented with double-stream voiding. He was passing a normal stream of urine through the hypospadiac tract, while a thin stream came out from the normal meatal site. Examination revealed a hypoplastic orthotopic urethra with an accessory penoscrotal hypospadiac urethra. The patient was successfully managed with hydrodistension technique which was used to resolve the stricture of hypoplastic dorsal urethra followed by end-to-end anastomosis to penoscrotal hypospadias. This approach gives an insight that the technique could be possibly considered as a simple alternative to avoid proximal hypospadias repair which is comparatively a challenging surgical task.
    International Urology and Nephrology 05/2014; · 1.33 Impact Factor
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    ABSTRACT: To report the results of endoscopic correction of vesicoureteral reflux (VUR) with concomitant injection of pure calcium hydroxyapatite (CaHA) and autologous blood. Records of patients who underwent endoscopic correction of VUR using concomitant injection of CaHA and autologous blood from 2008 through 2010 were retrospectively reviewed. Data regarding patients' demographics, preoperative VUR grades, febrile urinary tract infections, complications of procedure, postoperative VUR grades and cure rates were collected. Voiding cystourethrography was performed 3 months postoperatively. Total number of 23 children (9 girls and 14 boys) with 40 refluxing ureters were included. The mean age of children was 1.9 ± 0.97 (SD) years. Reflux grades were II to IV in 14, 11 and 15 renal refluxing units (RRUs), respectively. The mean follow-up period was 44 months. VUR was successfully treated in 87.5 % of RRUs after three injections. Significant statistical difference was found between VUR grades before and after the first, second and third injections (p < 0.001, p = 0.001 and p = 0.011, respectively). Moreover, there was a significant difference between primary reflux grade and treatment success (p = 0.031). Febrile UTI was resolved in 85 % of patients (17 of 20 patients with febrile UTI) after endoscopic treatment which shows significant improvement (p < 0.001). The procedure was uneventful in all patients, and no obstruction was reported during the follow-up period. Concomitant injection of pure CaHA without any additives (hyaluronic acid, etc.) and autologous blood can be an effective, repeatable and cost-benefit approach for the management of children suffering VUR with a success rate of 87.5 % after three injections.
    International Urology and Nephrology 02/2014; · 1.33 Impact Factor
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    ABSTRACT: To investigate the feasibility of biodegradable plate and screws for the tension-free internal fixation of the symphysis pubis in patients with bladder exstrophy, with a particular emphasis on pelvic bone changes as seen on 3-dimensional computed tomography. A total of 11 children with bladder exstrophy underwent surgical repair with biodegradable plate and screw fixation (mean age 4.13 years). Of the 11 patients, 6 had a history of failed bladder closures and pelvic osteotomies, 1 had failed bladder closure, and 4 had no such history. All 11 children underwent single-stage classic bladder closure. Subsequently, the symphysis pubis was fixed by placing a biodegradable miniplate and screws. The patients remained in leg bandages for 2 weeks. The follow-up period was 6-50 months (average 30.1). Three-dimensional pelvic bone computed tomography was performed initially and at 6 months postoperatively. All 11 children had an uneventful postoperative period, except for a superficial infection at the site of the suprapubic tube in 1 patient. The mean hospital stay was 13.4 days. The plate remained in situ, and no further surgery was needed to remove it. Pelvic 3-dimensional computed tomography revealed a 35.48 ± 1.50 mm, 20.06 ± 1.97 mm, and 10.73° ± 0.84° decrease in pubic diastasis, intertriradiate distance, and iliac wing angle at 6 months postoperatively, respectively. Significant improvement was seen in the patients' urinary continence and gait compared with the preoperative values. At the final follow-up visit, 6 patients were socially dry. Internal fixation of the pubic arch using biodegradable plates as a biocompatible alternative to current metal fixation system offers intriguing potential for early exstrophy management. This adds a layer of security to the pubic closure, in addition to the current surgical armamentarium for bladder exstrophy.
    Urology 01/2011; 77(5):1248-53. · 2.42 Impact Factor