Altaf Mangera

The University of Sheffield, Sheffield, England, United Kingdom

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Publications (74)232.78 Total impact

  • Altaf Mangera · Nadir Osman · Christopher Chapple

    No preview · Article · Feb 2016 · F1000 Research
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    Full-text · Article · Jan 2016 · F1000 Research
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    Altaf Mangera · Nadir Osman · Christopher Chapple

    Preview · Article · Jan 2016 · F1000 Research
  • Altaf Mangera · Christopher Chapple

    No preview · Article · Nov 2015
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    ABSTRACT: Pelvic fracture urethral injuries comprise one of the most challenging reconstructive procedures in urology. The obliterated or stenosed urethra can usually be effectively repaired by an end-to-end anastomosis (bulbomembranous anastomosis). To achieve this, a progression of surgical steps can be used to make a tension-free anastomosis. Before undertaking surgery it is important to comprehensively assess the patient to define their anatomical defects, in particular the site of the stenosis, the length of the distraction injury and the integrity of the bladder neck, and thus guide preoperative decision-making. Contemporary reports suggest that most pelvic fracture urethral distraction defects (PFUDD) can be adequately managed by a perineal approach. Nevertheless it is essential that all surgeons treating these injuries are familiar with the whole spectrum of operative steps that are necessary to repair PFUDD.
    Full-text · Article · Aug 2015 · Arab Journal of Urology

  • No preview · Article · Jun 2015 · The Clinical Teacher
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    ABSTRACT: Synthetic or biological materials can be used for the surgical repair of pelvic organ prolapse (POP) or stress urinary incontinence (SUI). While non-degradable synthetic mesh has a low failure rate, it is prone to complications such as infection and erosion, particularly in the urological/gynecological setting when subject to chronic influences of gravity and intermittent, repetitive strain. Biological materials have lower complication rates, although allografts and xenografts have a high risk of failure and the theoretical risk of infection. Autografts are used successfully for the treatment of SUI and are not associated with erosion; however, can lead to morbidity at the donor site. Tissue engineering has thus become the focus of interest in recent years as researchers seek an ideal tissue remodeling material for urogynecological repair. Herein, we review the directions of current and future research in this exciting field. Electrospun poly-L-lactic acid (PLA) and porcine small intestine submucosa (SIS) are two promising scaffold material candidates. Adipose-derived stem cells (ADSCs) appear to be a suitable cell type for scaffold seeding, and cells grown on scaffolds when subjected to repetitive biaxial strain show more appropriate biomechanical properties for clinical implantation. After implantation, an appropriate level of acute inflammation is important to precipitate moderate fibrosis and encourage tissue strength. New research directions include the use of bioactive materials containing compounds that may help facilitate integration of the new tissue. More research with longer follow-up is needed to ascertain the most successful and safe methods and materials for pelvic organ repair and SUI treatment.
    No preview · Article · May 2015 · Lower urinary tract symptoms
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    ABSTRACT: Introduction: The flap valve technique for creating a continent urinary diversion was popularized by Paul Mitrofanoff. Several tissues may be used to create the catheterizable vesicocutaneous channel but most commonly used are appendix and small bowel. Urine leakage from the channel occurs in ~4% of patients and is independent of the tissue utilized.1 A leaking Mitrofanoff channel has traditionally been corrected by revision or re-creation of the stoma altogether. We describe a minimally invasive technique with successful medium-term results in 50% of patients. Materials and Methods: A 14F Storz® adolescent cystoscope is inserted into the Mitrofanoff channel and cystoscopy is performed paying particular attention to the open channel neck. Three syringes containing 1 mL Durasphere® are prepared. An 18-g/22-cm needle (comes with Durasphere kit) is inserted down the cystoscope channel and all the air is expelled. The Durasphere beads are injected submucosally in to the channel neck as shown in the video (between bladder and the Mitrofanoff channel). This is performed at three circumferential sites to ensure good coaptation. The procedure may be repeated if leaking continues or reoccurs. Six patients with this problem underwent bladder diary and urodynamic assessment to reveal good bladder capacity and compliance with demonstrable leakage from the Mitrofanoff without detrusor overactivity. All leaking channels were obstructed with a catheter balloon and filled further to ensure a minimum of 500 mL bladder capacity with no significant change in intravesical pressure. Postoperatively, all patients were interviewed with a bladder diary at 6–8 weeks to assess subjective success. Failures underwent further urodynamic assessment. Results: Of six patients, five were female. Underlying diagnosis was spina bifida (n = 3), bladder extrophy, spastic diplegia, and Fowler's syndrome. Only one of the six patients was dry after the first injection, one patient required two injections, and a third patient required three injections. Follow-up for the three successful cases is 7, 10, and 28 months. Three patients chose revision after two injections for ongoing leakage. Two patients have had surgical revision and are dry. One patient is still awaiting revision. Importantly, revision was not more difficult due to the Durasphere as this material had been encapsulated and cored out easily. No patients had difficulty in inserting a catheter into their channel. Conclusions: Mitrofanoff leakage is a difficult and uncommon problem to deal with and we have described a minimally invasive technique that can be used to treat this problem. The success rate of 50% reflects the minimally invasive nature of the procedure, but most importantly, there was no demonstrable morbidity with this technique. In addition, subsequent surgical revision was not affected. To the best of our knowledge, this technique has not been described in detail in the literature before, although it is reported to have been used in small numbers of patients.2 The bulking agents used by various authors also differ and specific outcomes of this technique have not been reported yet. Therefore, we suggest that this technique has the potential to be the first-line treatment for a leaking Mitrofanoff channel but requires validation in larger numbers of patients with longer follow-up. No competing financial interests exist. Runtime of video: 4 mins 58 secs
    No preview · Article · Dec 2014
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    ABSTRACT: Assess patients' preferences in a pilot crossover study of two different electronic voiding diaries against a standard paper diary. Assess urological health professional (HP) opinions on the electronic bladder diary reporting system. Two different electronic diaries were developed: (1) electronically read diary-a card with predefined slots read by a card reader and (2) e-diary-a handheld touch screen device. Data uploaded from either electronic diary produced an electronic report. We recruited 22 patients split into two cohorts for each electronic diary, 11 completed each type of electronic diary for 3 days either preceded or followed by a standard paper diary for 3 days. Both diaries were completed on the 7th day. Patients' perceptions of both diaries were recorded using a standardized questionnaire. A HP study recruited 22 urologists who were given the paper diary and the electronic reports. Time taken for analysis was recorded along with accuracy and HP preferences. The majority of patients (82%) preferred the e-diary and only 1/11 found it difficult to use. Patients had the same preference for the electronically read diary as the paper diary. The paper diary took 66% longer to analyze than the electronic report (P < 0.001) and was analyzed with an accuracy of 58% compared to 100%. Slightly more HP (9%) preferred the electronic report to the paper diary. This proposed e-diary with its intuitive interface has overcome previous deficiencies in electronic diaries with most patients finding the format user-friendly. Electronic reports make analysis and interpretation by HP quicker and more accurate. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.
    No preview · Article · Sep 2014 · Neurourology and Urodynamics
  • Altaf Mangera · Christopher R. Chapple
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    ABSTRACT: Purpose of review: To review and evaluate the evidence from contemporary evidence-based guidelines regarding the assessment of men with urinary urgency and/or incontinence. Recent findings: There are a number of evidence-based guidelines which describe the pathways for assessing men with the symptoms of urgency and/or incontinence. We summarize the conclusions of the European Association of Urology, American Urological Association and National Institute of Clinical Excellence guidelines. Summary: All guidelines recommend a directed history, examination (including digital rectal examination), urinalysis and bladder diary as being essential in the assessment of men with lower urinary tract symptoms, although there are no high levels of evidence studies to support this. Creatinine estimation and prostate-specific antigen are recommended in selected groups of men, the latter after appropriate counselling. Uroflowmetry with postvoid residual assessment is recommended for at specialist assessment. Pad tests may be useful to quantify leakage. Ultrasound assessment of prostatic size and protrusion into the bladder base may be useful. Cystometry is recommended for men considering prostatic surgery, although there is a poor level of evidence underpinning this. Noninvasive surrogates for cystometry, such as penile plethysmography, lack sufficient evidence to allow recommendations to be made.
    No preview · Article · Aug 2014 · Current Opinion in Urology
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    ABSTRACT: Objective Family studies and twin studies demonstrate that lower urinary tract symptoms and pelvic organ prolapse are heritable. This review aimed to identify genetic polymorphisms tested for an association with lower urinary tract symptoms or prolapse, and to assess the strength, consistency, and risk of bias among reported associations. Study Design PubMed and HuGE Navigator were searched up to May 1, 2014, using a combination of genetic and phenotype key words, including “nocturia,” “incontinence,” “overactive bladder,” “prolapse,” and “enuresis.” Major genetics, urology, and gynecology conference abstracts were searched from 2005 through 2013. We screened 889 abstracts, and retrieved 78 full texts. In all, 27 published and 7 unpublished studies provided data on polymorphisms in or near 32 different genes. Fixed and random effects metaanalyses were conducted using codominant models of inheritance. We assessed the credibility of pooled associations using the interim Venice criteria. Results In pooled analysis, the rs4994 polymorphism of the ADRB3 gene was associated with overactive bladder (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7–3.6; n = 419). The rs1800012 polymorphism of the COL1A1 gene was associated with prolapse (OR, 1.3; 95% CI, 1.0–1.7; n = 838) and stress urinary incontinence (OR, 2.1; 95% CI, 1.4–3.2; n = 190). Other metaanalyses, including those for polymorphisms of COL3A1,LAMC1,MMP1,MMP3, and MMP9 did not show significant effects. Many studies were at high risk of bias from genotyping error or population stratification. Conclusion These metaanalyses provide moderate epidemiological credibility for associations of variation in ADRB3 with overactive bladder, and variation of COL1A1 with prolapse. Clinical testing for any of these polymorphisms cannot be recommended based on current evidence.
    Full-text · Article · Aug 2014 · American Journal of Obstetrics and Gynecology

  • No preview · Conference Paper · Aug 2014
  • Altaf Mangera · Christopher R. Chapple
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    ABSTRACT: Urethral stricture disease affects many men worldwide. A number of options exist for the treatment of this disease ranging from the more simple intermittent self dilatation, urethrotomy and dilatation, to the more technically demanding anastomotic and substitution urethroplasty. We discuss the aetiology, presentation, investigation and management of this disease. With a better understanding of the underlying pathophysiology and by adequately investigating the patient an informed decision may be made leading to good patient satisfaction and surgical success rates.
    No preview · Article · Jun 2014 · Surgery (Oxford)
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    ABSTRACT: Synthetic non-absorbable meshes are widely used to augment surgical repair of stress urinary incontinence (SUI) and pelvic organ prolapse (POP); however, there is growing concern such meshes are associated with serious complications. This study compares the potential of two autologous cell sources for attachment and extra-cellular matrix (ECM) production on a biodegradable scaffold to develop tissue engineered repair material (TERM). Human oral fibroblasts (OF) and human adipose-derived stem cells (ADSC) were isolated and cultured on thermo-annealed poly-L-lactic acid (PLA) scaffolds for two weeks under either unrestrained conditions or restrained (either with or without intermittent stress) conditions. Samples were tested for cell metabolic activity (AlamarBlue® assay), contraction (serial photographs analyzed with image J software), total collagen production (Sirius red assay), and production of ECM components (immunostaining for collagen I, III, and elastin; and scanning electron microscopy) and biomechanical properties (BOSE tensiometer). Differences were statistically tested using two sample t-test. Both cells showed good attachment and proliferation on scaffolds. Unrestrained scaffolds with ADSC produced more total collagen and a denser homogenous ECM than OF under same conditions. Restrained conditions (both with and without intermittent stress) gave similar total collagen production, but improved elastin production for both cells, particularly OF. The addition of any cell onto scaffolds led to an increase in biomechanical properties of scaffolds compared to unseeded scaffolds. OF and ADSC both appear to be suitable cell types to combine with biodegradable scaffolds, in the development of a TERM for the treatment of SUI and POP. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.
    Full-text · Article · Jun 2014 · Neurourology and Urodynamics
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    ABSTRACT: Introduction To assess the feasibility of converting from 300IU to 200IU OnabotulinumtoxinA in patients diagnosed with either idiopathic detrusor overactivity (IDO) or neurogenic detrusor overactivity (NDO). Material and methods Retrospective case–notes review of patients who were converted from 300IU to 200IU OnabotulinumtoxinA. Subjective patient reported improvements at interview and bladder diary reported parameters of urgency, urgency incontinence, frequency and nocturia. Results Forty–four patients had received 300IU OnabotulinumtoxinA and were switched to 200IU after July 2008, 28 for IDO and 16 for NDO. Thirty–seven patients reported ongoing improvement with 200IU OnabotulinumtoxinA, six patients had worsening in their symptoms since down–titrating to 200IU and one patient did not attend follow–up. Improvement in urgency and urgency incontinence episodes per day were 82% and 72%, respectively, in patients who received 200IU. Of the 44 patients, 39 continued to receive 200IU, four requested up–titration to 300IU (due to decreased effect) and one did not attend after the 1st treatment. After converting from 300IU to 200IU, additional three patients were started on CISC for de novo voiding difficulty. Conclusions Seventy–nine percent of patients were satisfied with their symptoms after switching from 300IU to 200IU OnabotulinumtoxinA. Only 9% of patients (all with NDO) reverted back to receiving 300IU. This study showed similar efficacy and longevity in the majority of patients (90%) using 200IU in both NDO and IDO.
    Full-text · Article · Apr 2014 · Central European Journal of Urology
  • Altaf Mangera · Nadir I Osman · Christopher R Chapple
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    ABSTRACT: The assessment of men with bladder outflow obstruction relies on an adequate history and examination. Uroflowmetry and post-void residue estimation are very revealing and may be sufficient in the majority of men. The prostate-specific antigen test may be used to select men who are at a high risk of progression. In specific situations, cystometry may be required. We discuss the use of cystometry and the newer less-invasive methods of assessment that have emerged over the last few years, including ultrasound estimation of intravesical prostatic protrusion, prostatic urethra angle, detrusor wall thickness, ultrasound-estimated bladder weight, near-infrared spectroscopy and the condom catheter and penile cuff tests. Although these techniques show promise, they still require further modifications, standardization and testing in larger populations. In addition, they should be used in men where only specific questions need to be answered.
    No preview · Article · Apr 2014 · Indian Journal of Urology
  • Altaf Mangera · Christopher R Chapple

    No preview · Article · Apr 2014 · Indian Journal of Urology
  • Nadir I Osman · Altaf Mangera · Christopher R Chapple
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    ABSTRACT: To review the use of non-hormonal pharmacotherapies in the treatment of lower urinary tract symptoms (LUTS) due to presumed benign prostatic hyperplasia (BPH). A search of the PUBMED database was conducted for the terms BPH, LUTS, bladder outlet obstruction, alpha-adrenoceptor blockers, anti-muscarinics, and phosphodiesterase-5-inhibitors. Medical therapy has long been established as the accepted standard of care in the treatment of male LUTS. The aim of treatment is improvement in symptoms and quality of life whilst minimizing adverse effects. The agents most widely used as 1(st) line therapy are alpha-blockers (AB), as a standalone or in combination with 2 other classes of drug; 5-α reductase inhibitors and anti-muscarinics. AB have rapid efficacy, improving symptoms and flow rate in a matter of days, these effects are then maintained over time. AB do not impact on prostate size and do not prevent acute urinary retention or the need for surgery. Anti-mucarinics, alone or in combination with an AB are safe and efficacious in the treatment of bothersome storage symptoms associated with LUTS/BPH. Phosphodiesterase-5 inhibitors are an emerging treatment option that improve LUTS without improving flow rates. AB are the most well-established pharmacotherapy in the management of men with LUTS/BPH. The emergence of different classes of agent offers the opportunity to target underlying pathophysiologies driving symptoms and better individualize treatment.
    No preview · Article · Apr 2014 · Indian Journal of Urology
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    Full-text · Article · Apr 2014 · European Urology Supplements
  • Altaf Mangera · Christopher R Chapple

    No preview · Article · Mar 2014

Publication Stats

422 Citations
232.78 Total Impact Points

Institutions

  • 2011-2015
    • The University of Sheffield
      • Department of Materials Science and Engineering
      Sheffield, England, United Kingdom
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2014
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom
  • 2010-2014
    • Sheffield Teaching Hospitals NHS Foundation Trust
      • Department of Medical Physics
      Sheffield, England, United Kingdom
  • 2013
    • East Sussex Healthcare NHS Trust
      Eastbourne, England, United Kingdom
  • 2012
    • The Rotherham NHS Foundation Trust
      Rotherdam, England, United Kingdom