Ashraf T Hafez

• Professor of Pediatric Urology, Urology & Nephrology Center, Mansoura University
• Professor at Urology and Nephrology Center

HYPOTHESIS / AIMS OF STUDY Pyeloplasty for ureteropelvic junction obstruction (UPJO) in pediatrics has traditionally been selected for cases of impaired renal drainage or renal function (RF) deterioration. However, there is a risk of possibly irreversible renal damage if RF deterioration occurs before pyeloplasty. Therefore, we evaluated the surgic...

Introduction Posterior urethral valve (PUV) is the leading etiology of lower urinary tract obstruction (LUTO) in boys and is an important cause of end-stage renal disease (ESRD) in children. The aim of this article is to review the current status on antenatal intervention for PUV as well as postnatal medical and surgical management. Main body MEDL...

Objectives to examine the durability of continent cutaneous catheterizable urinary channels (CCCC) in children and assess whether channel complications continue to arise with extended follow-up. Previous studies demonstrated that complications of CCCC cluster in the early years following surgery. Methods The database of a tertiary center was queri...

Introduction and Objectives We aim to assess the long-term oncological outcomes of children with bladder/prostate rhabdomyosarcoma (B/P RMS) treated with multiagent chemotherapy as a monotherapy. We hypothesize that a highly select patient subset can be treated with multiagent chemotherapy as a monotherapy and spared the morbidity of local treatmen...

Background: Urethral fibroepithelial polyps (FEPs) are scarce benign mesodermal tumors arising mainly from the posterior urethra in boys. FEPs are rarely reported in girls. There is no consensus regarding their etiology; however, some authors attribute their presence to abnormal mesodermal involution. FEPs have different clinical presentations, inc...

Background Hemostasis aimed to maintain the bloodless surgical field for better exposure for the surgeon. There are no trials regarding the impact of hemostasis techniques for hypospadias surgery on surgeon satisfaction and patients' reported outcomes. Application of penile tourniquet is a common practice in hypospadias surgery that aims at reducin...

Ureteral extension of childhood renal tumors is exceedingly rare. Hematuria, hydronephrosis, poorly or non-functioning kidney should raise suspicion for ureteral tumor extension. Identifying ureteral extension on preoperative imaging or intraoperatively before ureteral transection is crucial to obtain good oncological outcome without unnecessary ex...

Keloid scars result from excess collagen deposition in the dermis or subcutaneous tissue in response to surgery or tissue trauma. The penis is a rare site for keloid formation, even in predisposed individuals. Only few cases of penile keloids have been reported so far. In this report, we present penile keloids complicating neonatal circumcision in...

Objectives: To study the effect of oxybutynin treatment on the bladder and upper urinary tract outcomes following posterior urethral valve (PUV) ablation in infancy. Materials and methods: Infants less than 12 months diagnosed with PUV and treated with primary endoscopic valve ablation (EVA), were screened for eligibility. Patients treated with...

Objective To report our experience with different approaches for management of pouch stones in children with an ileal-based urinary reservoir.

Objectives: To demonstrate the long term outcome of a contemporary series of 64 children who underwent CPRE in a single tertiary referral center. Methods: Between 1998 and 2012, 64 children; 47 boys and 17 girls were identified. Only 60 out of the 64 cases were available for follow up. Follow up was done by renal bladder ultrasound (RBUS) and se...

Cloacal duplication is an exceedingly rare group of anomalies with a limited number of cases reported so far. The anomaly may be confined to partial bladder duplication or it may involve complete duplication of the urogenital tract, hindgut, spine, lower limbs and vascular structures. Every case is unique and ought to be approached individually. By...

Bladder neck closure (BNC) is the ultimate bladder neck reconstruction. If reconstruction fails, closure must be considered as it gives the highest continence rate. The vast majority of bladder neck closures are performed through an abdominal approach (either transvesical or extravesical approach), but perineal approach remains an option for BNC wi...

We sought to evaluate the long-term outcomes of Bricker's conduit in children in a contemporary series. the database of a single tertiary center was retrospectively reviewed for children who had ileal conduits between 1981 and 2011. Patients followed-up for less than one year were excluded. Patients' files were reviewed for demographics, diversion...

To test the predictive value of distal ureteral diameter (UD) on reflux resolution after endoscopic injection in children with primary vesicoureteral reflux (VUR). This was a retrospective review of patients diagnosed with primary VUR between 2009 and 2012 who were managed by endoscopic injection. Seventy preoperative and postoperative voiding cyst...

Introduction: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children. Methods: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL)...

Objective: To study the predictive value of 6 ultrasonographic (USG) parameters for early detection of children at risk of recurrent obstruction. Patients and methods: A prospective nonrandomized study included all patients who underwent pyeloplasty between 2010 and 2012. All of the patients had completed at least 6 months of follow-up and preop...

Aim: To analyze the status of renal function after pyeloplasty in a large contemporary adult series and to detect which variables predict improvement of renal function. Materials and methods: 85 adult patients were retrospectively identified who had undergone pyeloplasty between January 2002 and May 2011 with available pre- and postoperative diu...

Objectives To review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery. Patients and methods We retrospectively reviewed all cases of testi...

To evaluate the prognostic role of antenatal diagnosis of posterior urethral valves (PUVs) on ultimate renal function. Between 1990 and 2010, 315 patients with PUVs were diagnosed and treated at 2 separate tertiary centers. Primary valve ablation was performed in all patients except 18, who underwent initial vesicostomy. Patients were divided into...

Purpose: To evaluate the long-term outcome of visual internal urethrotomy (VIU) after perineal anastomotic urethroplasty for posttraumatic pediatric posterior urethral strictures. Patients and methods: Data of 22 boys who had undergone internal urethrotomy for recurrent stricture after perineal anastomotic urethroplasty for posttraumatic posteri...

Purpose: Previous series showed controversial differential renal function outcomes after pyeloplasty in children. However, they were limited by study power, methodology and lack of comparable end points. We determined the status of differential renal function after pyeloplasty in children in what is to our knowledge the largest series to date. Ma...

Complete penile disassembly (CPD) is a widely utilized procedure for epispadias repair. The rarity of the anomaly and limited number of patients in published series limit our ability to fully evaluate the outcome of such a technique. We reviewed the literature for published data on CPD. We looked at different complications of the procedure and the...

To give a retrospective analysis of factors affecting outcome of tubularized incised plate (TIP) repair for penoscrotal hypospadias. Data of all patients who underwent TIP repair for penoscrotal hypospadias by a single surgeon were retrieved. Follow-up was carried out every 3 months within the first year and annually thereafter. Repairs were divide...

To examine the efficacy and tolerability of tizanidine for the treatment of dysfunctional voiding in children compared with those of doxazosin. A total of 40 children with dysfunctional voiding were enrolled in a prospective, randomized, 2-parallel group, flexible-dose study. The evaluations were performed in accordance with the International Child...

To present the outcomes of complete penile disassembly in 14 postpubertal patients. Complete penile disassembly is widely used for epispadias repair. From July 2001 to May 2008, a total of 14 postpubertal patients underwent complete penile disassembly epispadias repair. The median age at surgery was 18 years (range 14-34). Of the 14 patients, 3 pat...

To evaluate the outcome of the detrusor wraparound bladder neck technique of bladder neck reconstruction in 28 children with bladder exstrophy. The records of all patients with bladder exstrophy who underwent detrusor wraparound bladder neck were reviewed. A total of 28 consecutive patients were identified and included 21 boys and 7 girls, with a m...

We evaluated the functional outcome of continent catheterizable outlet using the serous lined extramural tunnel technique as a continence mechanism in children and adolescents. We retrospectively studied all patients who underwent continent catheterizable stoma using the serous lined extramural technique between May 1993 and March 2008. Patient rec...

The aim of the study was to report the surgical complications that may occur during or after primary ablation of posterior urethral valve (PUV) in a large number of cases treated using different modalities. We retrospectively reviewed a database of 291 patients with PUV treated by primary valve ablation from 2 separate centers between 1987 and 2006...

PurposeWe studied VUR resolution and risk of pyelonephritis following bladder augmentation.Material and Methods Between February 2005 and March 2009, 42 patients underwent ileocystoplasty for non-compliant bladder at a mean age of 9 years (range 4-17). Patients included 29 boys and 13 girls. The indications are neuropathic bladder (NB) in 19, poste...

Purpose The use of a demucosalized detrusor pedicle flap as a bladder neck wrap was described by Mitchell. The outcome of this novel technique of bladder neck reconstruction (BNR) in 28 children with bladder exstrophy is presented. Material and Methods The records of all patients who underwent bladder neck reconstruction using DWBN were reviewed....

Purpose This is a retrospective analysis of factors affecting outcome of TIP repair for penoscrotal Hypospadias. Material and Methods Data of all patients who underwent TIP repair for penoscrotal Hypospadias by a single surgeon (A.T.H) were retrieved. Significant chordee (> 30 degree) was a contraindication for TIP. Chordee was corrected after ext...

Purpose We report on the perineal approach for urogenital sinus mobilization. Material and Methods The records of 16 girls undergoing UGS were reviewed. Diagnosis was congenital adrenal hyperplasia (CAH) in 13 girls, and persistent UGS in 3. Mean age at surgery was 5 years (range 1 to 10). Four CAH patients had previous reduction clitoroplasty don...

To review our experience of tubularized incised plate (TIP) urethroplasty in children with hypospadias defects. Of 500 children (mean age 6 years) who received a TIP urethroplasty, 439 (87.8%) had primary hypospadias and 61 had one failed previous repair. The hypospadias defects were coronal in 110 (22%), distal penile in 261 (52.2%), midpenile in...

We studied the effect of suturing technique and the impact of urethral plate characteristics on the complication rate following tubularized incised plate urethroplasty. We prospectively studied 80 boys (mean age 4.5 years, range 3 to 7) with primary hypospadias in a randomized fashion between January 2004 and May 2005. Of the patients 64 had anteri...

Purpose Providing continence for children with non compliant bladder and low detrusor leak point pressure secondary to neuropathic dysfunction or bladder exstrophy is a challenging task. A one stage reconstruction triad is presented. Material and Methods Between May 2005 to July 2008, 21 patients underwent DWBN, ileocystoplasty, and extramural ser...

Purpose CPD is widely utilized for epispadias repair. Herein, the outcome of such technique in 14 post pubertal patients is presented. Material and Methods Between July 2001 and May 2008, a total of 14 post pubertal patients underwent CPD epispadias repair. Mean age at surgery was 18.9 years (range 14-34). Eleven patients were born with bladder ex...

We report our experience with ureterocalyceal anastomosis in children regarding indications and outcome. A retrospective review was performed of all cases that underwent open ureterocalyceal anastomosis at our center between 2000 and 2006. Records were reviewed for patient age, history, affected side, indication of surgery and operative details. Cl...

To evaluate the outcome of secondary surgical procedures for the management of failed pyeloplasty in children. Between 1996 and 2007, 590 cases of primary ureteropelvic junction (UPJ) obstruction underwent open dismembered pyeloplasty at our center. Of these patients, 18 (3%) with recurrent UPJ obstruction (14 males, 4 females; age range: 2-15 year...

The purpose of this study was to define the structural response of unresectable Wilms' tumor following preoperative chemotherapy by computed tomography (CT). We also compared CT changes in relation to histopathological nature. The study included 36 patients with 41 nephroblastomas. All were examined by CT before preoperative chemotherapy using mult...

To evaluate the efficacy of oxidized cellulose, Surgicel(TM) (Johnson & Johnson Medical, New Brunswick, NJ, USA) for patching defects in the tunica albuginea in a rabbit model, with a future application to correct chordee. The study comprised nine New Zealand white male rabbits; a rectangular 15 x 5-mm defect was created in the ventral tunica albug...

To present our experience with ureteroscopy for the treatment of pediatric ureteral calculi. The records of 32 children with an average age of 8.7 years (range 2-15 years) treated with rigid ureteroscopy between June 1994 and July 2003 were reviewed. In 33 ureteral units, 8F rigid ureteroscopy was carried out 35 times to treat stone disease. Stones...

This work aims at evaluation of chemotherapy as mono-therapy for treatment of non-metastatic bladder/prostate embryonal rhabdomyosarcoma in children. Between 1996 and 2002, 10 children presented with RMS of the bladder/prostate at a mean age of 6.6 years (range 1.5-18). Four patients had stage 2 disease and 6 had stage 3. The histology was embryona...

Complete primary repair (CPR) of bladder exstrophy using Mitchell's technique gained wide popularity. We present a single center experience with CPR in 30 children with bladder exstrophy presenting late or after failed initial closure. Between November 1998 and November 2003, 45 patients underwent CPR of bladder exstrophy using Mitchell's technique...

In a pilot study we developed a cell transfer technology for populating demucosalized colonic segments with bladder urothelium. This process was achieved through aerosol transfer of a single cell suspension consisting of bladder urothelial cells, smooth muscle cells and fibrin glue onto demucosalized colonic segments. We further evaluate this new c...

We studied the acetabular coverage in bladder exstrophy patients and normal control children. The study included 13 patients with bladder exstrophy, who were divided according to their ages into group I below 5 years, group II between 5 and 10 years, and group III above 10 years of age. Four normal children served as controls, 2 were below 5 years,...

To study the effect of pyeloplasty and conservative management on renal function in children with pelviureteral junction obstruction. This prospective study included 65 children postnatally diagnosed with unilateral pelviureteral junction obstruction. On the basis of the patients' symptoms and technetium-99m diethylenetriamine pentaacetic acid rena...

Complete repair of classic bladder exstrophy in male newborns has been successful with minimal morbidity. However, the technique may create hypospadias in some cases. We have recently adopted a modification to obtain an orthotopic meatus in bladder exstrophy boys. Between November 1998 and December 2002 complete repair of classic bladder exstrophy...

In our hands complete primary repair (CPR) of bladder exstrophy results in hypospadias in two-thirds of boys. To our knowledge hypospadias repair following CPR of bladder exstrophy has not been reported previously. We report our experience with hypospadias repair following CPR of bladder exstrophy. A total of 22 boys with bladder exstrophy underwen...

To evaluate the long-term results of one-stage perineal anastomotic urethroplasty for post-traumatic paediatric urethral strictures. Thirty-five boys who had a perineal anastomotic urethroplasty for post-traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (rang...

We evaluated the long-term results of visual internal urethrotomy for pediatric urethral strictures to evaluate the efficacy and final outcome of this procedure in children and to evaluate the risk factors for stricture recurrence. The computerized surgical records of our hospital were reviewed to identify children who underwent visual internal ure...

To evaluate the use of single-layer small intestinal submucosa (SIS) and tunica vaginalis flap (TVF) for covering defects in the ventral surface of the tunica albuginea to correct severe penile chordee. In all, 24 New Zealand white rabbits had a rectangular area excised from the ventral surface of tunica albuginea. In 12 rabbits TVF was used to cov...

To evaluate the use of commercially available single-layer small intestinal submucosa (SIS) for urethral replacement, both as an onlay and as a tube, in a rabbit model. Thirty-six male rabbits were assigned to four experimental groups. Group 1 had the ventral wall of the penile urethra excised for 15 mm; in group 2 this created defect was patched w...

We report our experience with percutaneous nephrolithotomy (PCNL) in children, and evaluate its early and late anatomical and functional results. A total of 65 children with renal calculi were treated with PCNL. Patient age at operation ranged from 9 months to 16 years (mean +/- SD of 5.9 +/- 0.9 years), and 27 (41.5%) were younger than 5 years. Se...

To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. Nine New Zealand white male rabbits were utilized. All had a 15 x 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea...

We evaluated the use of 4 vs 1 layer small intestinal submucosa (SIS) for covering defects in the ventral surface of the tunica albuginea to correct severe chordee. A total of 18 New Zealand white rabbits underwent implantation of a 10 x 5 mm SIS graft following excision of a rectangular area in the ventral surface of the tunica albuginea. In 9 rab...

To assess the long-term results in children with high-grade renal trauma who were managed without surgery, as such treatment was initially successful but little is known about the late ipsilateral renal function and morphology. The study included 13 children (nine boys and four girls; mean age 8 years, sd 5) with high-grade renal injury who were ma...

To retrospectively review our experience of the tubularized incised-plate (TIP) urethroplasty over the last 4 years. From 1998 to December 2001, 133 patients (mean age 7 years, sd 4, range 1-22), had a TIP urethroplasty by one surgeon for primary (103) and re-operative (30) hypospadias; the defects included 106 (79%) distal and mid-shaft, and 27 (2...

Previous studies have demonstrated successful use of small intestinal submucosa (SIS) as a tube for replacing short segment (11 mm) proximal ureteral defects. However, such small segment ureteral defects could be managed by resection re-anastomosis. We evaluated the use of 1-layer SIS as a tube for the replacement of long segment ureteral defects....

We developed a reproducible animal model for the induction of urethral stricture in the rabbit and evaluated the role of halofuginone in limiting stricture formation. A total of 20 New Zealand male rabbits were used in the first phase of the experiment. Bulbar urethral stricture was induced by electrocoagulation. The animals were then randomly assi...

We evaluated the long-term effects of ileocystoplasty on linear growth, serum electrolytes, acid-base profile and bone mineral density (BMD) in a group of neurologically intact children with a mean followup of 8.9 years. Between 1988 and 1997, 9 girls and 16 boys with a mean age of 6 years (range 1 month to 14 years) underwent ileocystoplasty for e...

We developed a cell transfer technology for covering demucosalized colonic segments with bladder urothelium. This covering would be achieved through aerosol spraying of single cell suspension of bladder urothelial and smooth muscle cells with fibrin glue onto the demucosalized colonic segments. In 6 piglets (20 kg.) a 4 cm.2 area of bladder was exc...

OBJECTIVE To develop a rabbit model to study the temporal healing taking place after an unstented tubularized incised plate urethroplasty (TIPU).MATERIALS AND METHODS The study comprised 13 New Zealand white rabbits (3–4 kg); the ventral wall of the penile urethra was excised to create a hypospadias-like defect. A vertical incision was made in the...

The surgical repair of bladder exstrophy remains challenging for the urologist. Recently, complete primary repair has been used in neonates. We present our experience with this approach in neonates and children after failed initial closure. Between November 1998 and November 2000, 17 boys and 2 girls with bladder exstrophy underwent complete repair...

Ureteroneocystostomy in children with posterior urethral valves represents a surgical challenge. We reviewed our experience with this procedure to assess its indications and outcome. Between 1996 and January 2000, 106 children with posterior urethral valves were treated of whom 20 (19%) underwent ureteroneocystostomy at a mean age plus or minus SD...