Mohamed A Eissa

Cairo University, Al Qāhirah, Muḩāfaz̧at al Qāhirah, Egypt

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Publications (10)14.33 Total impact

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    ABSTRACT: Objective: To assess the effectiveness of visual laser ablation treatment with holmium:yttrium-aluminum-garnet (Ho:YAG) laser in pediatrics with urethral strictures and to compare the results with those obtained in patients treated with visual internal urethrotomy(VIU) urethrotomy. Materials and Methods: From January 2010 to January 2013, 32 male patients aged 2 to 70 years (mean age 10.2) with primary urethral strictures 0.5 to 1.5 cm long qualified for the study. 19 cases with the stricture length less than 1 cm and in 13 cases the length was more than 1.0 cm .17 cases with the stricture in anterior urethra and 15 cases with the stricture in posterior urethra The patients were treated using visual laser ablation of urethral strictures (VLASU) with holmium:YAG laser. All the patients were investigated preoperatively by uroflowmetry and ascending cystourethrogram with micturating urethrogrm and were followed up postoperatively with uroflowmetry and ascending cystourethrogram at 3 months and 6 months. Urethrotomy was made at the 12 o’clock position by retrograde vaporization of the scarred tissue through the total length of the stricture with the aid of a metal guidewire. Results: At 6-month follow-up, 21 cases (65.6%) did not require repetition of the procedure. The mean operation time was 30.8 minutes (range 20–45 minutes). The mean peak urinary flow rate (Qmax) was 6.41± 1.78 l/s. the mean Qmax postoperative at 3 months was 17.26±5.9 and at 6 months postoperative was 15.7±7.21 Conclusion: VLASU can be used as a method of treatment of this disorder. It is an effective, modern, low-invasive, and repeatable technique and is technically simple and easy to master with results comparable to those of conventional urethrotomy. Keywords: stricture urethra, holmium: YAG laser, visual internal urethrotomy
    The 34th Congress of the SIU in Glasgow, held from October 12-15, 2014., Glasgow; 10/2014
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    ABSTRACT: Keywords: electric stimulation, urinary incontinence, Urodynamic, overactive bladder The Aim of this study was focused on efficacy of percutaneous posterior tibial nerve stimulation (PTNS) for the treatment of the overactive bladder and evaluation of Urodynamic parameter after treatment. Materials and methods The study(prospective study) includes 20 children who are complaining from overactive bladder symptoms( frequency, urgency, nocturia and urge incontinence) with no underling neurological deficit ,selected from Abo Alresh hospital. We used weekly PTNS for 12 weeks. A needle electrode is inserted into the ankle and the lead wire is connected to the stimulator. A surface electrode is then placed in the medial aspect of the calcaneus on the same leg. The cycle last for 30 minutes. Then the children were evaluated after3 months by bladder diary and Urodynamic test. Results: 60% of the patients with complaints of OAB symptoms reported a statistically significant subjective success. Also patients showed improvement of frequency 12 out of 20 (60%), and urgency 11 out of 20 (55%), nocturnal enuresis 10 out of 16 (63%) and urge incontinence 8 out of 15 (53%) and improvement of Urodynamic parameters include detrusor over activity 14 out of 20 (70%), mean bladder capacity increase significantly from 184.5 ± 59.14 to259.5 ± 77.22 (p=0.000) and insignificant improvement of bladder compliance 5 out of 18 (30 %). Conclusions: Posterior tibial nerve stimulation (PTNS) is an effective, minimally invasive option for the treatment of patients complaining of overactive bladder with an easily accessible stimulation site.
    The 34th Congress of the SIU, Glasgow; 10/2014
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    ABSTRACT: INTRODUCTION: Management of vesical calculi in children poses an interesting challenge to the urologist. The treatment options currently available include open surgery, transurethral pneumatic cystolithotripsy, percutaneous suprapubic cystolithotomy and shockwave lithotripsy (SWL). Holmium: YAG (Ho: YAG) laser cystolithotripsy represents a novel modality of treatment that is minimally invasive. MATERIALS AND METHODS: From January 2010 to May 2011, we treated 33 children with vesical calculi using transurethral Ho: YAG laserlithotripsy. The mean stone size was 2.02 cm (range 1-4). The mean patient age was 3.75 (range 6 months-11) years. Access was obtained with a cystoscope with sheath 11 F and holmium laser energy (2.75 J/pulse at 11 Hz and power at 30 watt) was applied through a 0.73-mm end-firing fibre under video guidance. The calculi were fragmented to tiny fragments about 2-3 mm in size. An 8F silicone urinary catheter was placed for 3 days in all patients. Post-operatively the children were evaluated at 3 and 12 months with radiological imaging and uroflowmetry to confirm stone-free status and exclude urethral stricture formation. RESULTS: The mean duration of the endoscopic procedure was 32 (range 20-50) minutes while the length of hospital stay was 24 hours for all patients. All the children were rendered stone-free following a single operative session. Laser-induced major complications were not observed in any of the children. At the mean follow-up of 16 (range 12-24) months none of the children developed stone recurrence, urinary tract infections or urethral strictures. CONCLUSIONS: Transurethral Ho: YAG laser lithotripsy was found to be an efficient and safe modality for the treatment of vesical calculi in children.
    The 34th Congress of the SIU, Glasgow; 10/2014
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    ABSTRACT: OBJECTIVE: Urolithiasis in infants can cause considerable morbidity. The literature regarding calcular anuria in this age group is very defective. Our aim was to evaluate impact of intervention on renal recoverability in these infants. PATIENTS AND METHODS: A series of 24 patients presenting with obstructive calcular anuria were included in this study. Mean age was 16.5 ± 6.2 months. They were treated either by initial urinary diversion or definitive endoscopic (ureteroscopy or JJ stenting with medical alkalinization) or open surgical (ureterolithotomy or pyelolithotomy) treatment. RESULTS: Mean serum creatinine was 5.8 ± 2.6 mg/dl. Initial peritoneal dialysis and/or urinary diversion was needed in 11 patients (45.8%). Open surgical treatment was applied in 5 (20.8%), endoscopic treatment was applied in 15 (62.5%), while combined treatment was applied in 4 (16.6%) patients. All patients had normal serum creatinine on discharge. Three (12.5%) had residual stones which were cleared by 2ry ureteroscopic intervention at 6 months. The overall complication rate in this study was 12.5% in the form of postoperative leakage (1) and postoperative fever (2). No mortality or development of chronic renal failure was reported at 6 months follow up. In comparison with these results, a previous study carried out in our centre on an older age group had a higher complication rate (28%) with higher mortalities and lower renal function recoverability rate (94%). CONCLUSIONS: Appropriate and timely medical and surgical management of calcular anuria will mostly lead to full recovery of renal functions. In comparison with older children, renal prognosis in those less than 2 years seems more favorable.
    Journal of Pediatric Urology 12/2013; 9((6 Pt B)):1178-82. DOI:10.1016/j.jpurol.2013.05.003 · 1.41 Impact Factor
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    ABSTRACT: OBJECTIVE: To compare treatment results in patients who underwent pyeloplasty with and without pelvic reduction for ureteropelvic junction obstruction (UPJO). METHODS: This randomized prospective study involved 40 patients, all diagnosed with unilateral UPJO; 20 each were randomly selected to undergo open dismembered pyeloplasty with pelvic reduction (group A) or pelvis-sparing pyeloplasty (group B). Patients were evaluated with ultrasound and DPTA renography scans 6 months postoperatively. Mean follow-up was 9 months. RESULTS: The mean age in group B was 5.71 ± 6.36 years; in group A it was 4.81 ± 6.78 years. There was a decrease in mean anteroposterior renal pelvic diameter (from 49.9 to 26.35 ± 0.949 mm in A and 50.9 to 30.8 ± 1.556 mm in B) with improvement of split renal function (from 39 ± 22.47% to 42.4 ± 22.13% in A and 34.92 ± 16.79% to 38.8 ± 19.66% in B), glomerular filtration rate (from 37.25 ± 15.33 to 41.7 ± 19.34 ml/min in A and 31.3 ± 18.50 to 38.1 ± 23.23 ml/min in B) and draining curves on the 6-month scans, but without any significant difference between groups (p > 0.05). Two cases in group A and three in group B needed redo pyeloplasty, but without any significant difference in failure rate. CONCLUSION: Excision of the pelvis is not necessary in dismembered pyeloplasty procedures. We had similar surgical outcomes for patients with or without pelvis reduction.
    Journal of pediatric urology 06/2013; 9(3):303-7. DOI:10.1016/j.jpurol.2012.03.002 · 1.41 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children. PATIENTS AND METHODS: In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months. RESULTS: 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p < 0.001). Complications were encountered in 18 patients; 2 underwent auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse. CONCLUSION: ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm.
    Journal of pediatric urology 06/2013; 9((3)):323-7. DOI:10.1016/j.jpurol.2012.04.003 · 1.41 Impact Factor
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    ABSTRACT: Urolithiasis in children can cause considerable morbidity. Our aim was to evaluate the impact of intervention on the recoverability of kidney functions. This prospective study included 93 children (66 boys and 27 girls) with median age of 3 years (range 0-14). Inclusion criteria were presence of anuria, oliguria, serum creatinine >2 mg% and/or hyperkalemia ≥ 6 mmol/L. The mean duration of anuria or oliguria was (mean ± SE) 5.3 ± 0.4 days. On presentation, mean plasma creatinine was 6.5 ± 0.29 mg/dl with a mean estimated glomerular filtration rate (eGFR) of 14 ml/min and creatinine clearance (CC) of 8.24 ml/min. Dialysis was performed in 21 (22.6%) patients. When condition allowed, emergency surgery was performed. Mean follow up was 1.5 years with compliance of 82%. At the end of treatment, 83% of patients had complete clearance of calculi. Mean plasma creatinine after treatment was 3.3 ± 0.35 mg/dl with an average GFR of 24.5 ml/min. After treatment renal function returned to normal in 57%, improved in 27% and deteriorated in 16% of children. Renal function recoverability rate was 94.6%. Chronic renal failure developed in 3 (3.2%) patients and 2 (2.2%) patients died. When absolute plasma creatinine concentration [P(cr)] improved 20-50% the eGFR and CC were doubled, and when improved 50-70% eGFR and CC tripled. Beyond 70% improvement in [P(cr)], eGFR and CC improved 7-8 times. Using Spearman's correlation, the mode of presentation and the type of management had a significant correlation with renal function outcome (P = 0.019 and 0.013 respectively). Urgent management of calcular anuria both medically and surgically is the cornerstone for favorable outcome. The mode of presentation and the type of management are significant factors affecting final renal function outcome.
    Journal of pediatric urology 06/2011; 7(3):252-6. DOI:10.1016/j.jpurol.2011.02.011 · 1.41 Impact Factor
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    ABSTRACT: To review the impact of major pediatric renal trauma and its management on long-term function and morphology of the injured kidney. Thirty-six blunt trauma patients (20 males, 16 females) presented in 2004-2007 (age range 2 days to 14 years; mean 6.2 years). Thirty-seven renal units were included: 13 grade III, 14 grade IV, and 10 grade V injuries. Follow up was for 3-38 (mean 14) months. Patients were managed non-operatively unless vitally unstable. The most common causes of trauma were motor vehicle accidents and falls. Fourteen patients had associated non-renal injuries. Four patients had pre-existing renal problems. The surgical intervention group (13 patients, 36%) included 9/10 grade V and 4/14 grade IV renal injuries. Surgical repair of lacerations was performed in seven cases, partial nephrectomy in four cases and nephrectomy in two cases. Follow up showed no significant change in renal function, and none developed hypertension. The non-operative group (24 patients, 63.2%) included all grade III injuries, 10 grade IV injuries, and one grade V injury. There was an excellent outcome for 18/24 patients (75%) with kidney preservation, no complications from urinary extravasation and hematoma resolution. The remaining patients had lower polar infarction (1), renal atrophy (1), persistent subcapsular collection (2), recurrent hematuria requiring angioembolization (1), and there was one death related to central nervous system injury. The outcome of our management of pediatric major renal trauma was favorable overall. Longer follow up is needed with regard to renal function and development of hypertension.
    Journal of pediatric urology 10/2009; 6(3):301-5. DOI:10.1016/j.jpurol.2009.09.009 · 1.41 Impact Factor
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    ABSTRACT: Reconstruction of bladder exstrophy remains a challenge. We evaluated our experience with complete primary repair in classic bladder exstrophy. A retrospective data review was conducted of bladder exstrophy patients presenting at our institution between May 2000 and September 2007. Fifty-one patients (21 females and 30 males) with classic bladder exstrophy were included. Age of presentation ranged from 24h to 14 months. Mean follow up was 3 years (1 month-7 years). Patients were evaluated for continence, upper tract dilatation and cosmetic result. Eight patients (15.6%) had failed closures and six (11.7%) had fistulae. Evaluation of continence excluded 16 patients not followed up at our center. Thirty-seven percent were continent on clean intermittent catheterization after the age of 5 years. Patients became dry only after augmentation cystoplasty. Upper tract changes were mild during our study with all patients having normal serum creatinine. Patients may require more than one procedure for reconstruction. In our series, augmentation was required to achieve acceptable dryness. Early promising results with dry intervals in young patients did not translate to continence in older patients.
    Journal of pediatric urology 06/2009; 5(6):496-9. DOI:10.1016/j.jpurol.2009.03.015 · 1.41 Impact Factor
  • The Journal of Urology 04/2008; 179(4):386-386. DOI:10.1016/S0022-5347(08)61131-3 · 3.75 Impact Factor