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Biomedical subjects

A A Shokeir

Publications and source records attributed to A A Shokeir.

At least 19 recordsLinked to original sources
PubMed1997

Partial ureteral obstruction: effect of intravenous normal saline and furosemide upon the renal resistive index.

OBJECTIVE: To investigate the effect of intravenous normal saline fluid load, with and without furosemide, upon the renal resistive index (RI) of obstructed and nonobstructed kidneys. METHODS: Right partial ureteral obstruction was induced in 10 dogs. Grade 1 (mild) obstruction was performed in 5 dogs (group A), and grade 3 (severe) obstruction was carried out to the remaining 5 dogs (group B). Evaluation by Doppler ultrasonography was performed before induction of ureteral obstruction and by the end of the 8th week of obstruction. Every obstructed animal was subjected to bilateral renal Doppler ultrasonography 3 times in one setting: 1) before infusion of normal saline, 2) 30-60 minutes after intravenous infusion of normal saline (15 ml./kg.) given in a rate of 1 ml./kg./min. and 3) 10 minutes after admission of furosemide (1 mg./kg.). RESULTS: After induction of right partial ureteral obstruction, there was a significant increase of the RI of the right kidney and a significant decrease of the RI of the left kidney compared to baseline RI in both groups. Infusion of normal saline and administration of furosemide caused a further significant increase of the RI of the obstructed kidney and a further significant decrease of the RI in the nonobstructed kidney in both groups. CONCLUSION: In unilateral partial ureteral obstruction, addition of intravenous normal saline and furosemide cause the RI to increase in obstructed kidney and to decrease in nonobstructed kidney. Such a divergent response may be useful for the development of a pharmacologically challenged Doppler examination to diagnose better potentially obstructed kidneys.

Animals↗
PubMed1997

Emphysematous pyelonephritis: a 15-year experience with 20 cases.

OBJECTIVES: To review our experience with emphysematous pyelonephritis over the past 15 years. METHODS: Twenty patients with emphysematous pyelonephritis were reviewed regarding diagnosis, treatment, and outcome. RESULTS: Women outnumbered men (75% versus 25%), and 80% of patients were diabetic. The left kidney was more frequently affected than the right one (60% versus 35%) and both kidneys were involved in 5%. Obstruction of the corresponding renoureteral unit was found in all the nondiabetic and in half of the diabetic patients. Diagnosis was confirmed by gas in the parenchyma or perinephric space by plain x-ray of the abdomen or computed tomography. Escherichia coli was the most common organism; it was found in 70% of urine cultures. A prompt attempt to control diabetes was made, and intravenous antibiotics were given. Nephrectomy was immediately performed after stabilization of the general condition of the patients. A total of 80% of patients survived the procedures. CONCLUSIONS: For successful management of emphysematous pyelonephritis, appropriate medical treatment should be attempted but immediate nephrectomy should not be delayed.

Aged↗
PubMed1997

Partial ureteral obstruction: role of renal resistive index in stages of obstruction and release.

OBJECTIVES: To study the changes in renal resistive index (RI) and renal function before and after release of different grades of partial unilateral ureteral obstructions. METHODS: Ten dogs were subjected to right partial ureteral obstruction. Grade 1 (mild) obstruction was applied to 5 dogs (group A) and grade 3 (moderate and severe) obstruction was applied to the other 5 dogs (group B). Obstruction was maintained for 8 weeks, followed by release of obstruction. All dogs were subjected to excretory urography, technetium-99m mercaptoacetyltriglycine diuretic renography with calculation of half-time drainage (T1/2), and bilateral renal Doppler ultrasonography before the start of the experiment, after 8 weeks of obstruction, and every 2 weeks during the 8 weeks after release of obstruction. RESULTS: In both groups, after induction of right ureteral obstruction, there was a dramatic decrease of effective renal plasma flow (ERPF), increase of RI, and increase of T1/2 of the right kidney. Relief of obstruction was associated with normalization of T1/2, reversal of RI, and recovery of ERPF to near basal values. No correlation was found between ERPF at the end of the recovery period and the functional parameters (T1/2, RI, or ERPF) of the obstructed kidney before release of obstruction. CONCLUSIONS: (1) Unilateral partial ureteral obstruction produces an elevation of RI and T1/2 and a fall in ERPF of the corresponding kidney. (2) After relief of function is regained with associated reversal of RI. (3) Functional parameters (T1/2, RI, or ERPF) of the obstructed kidney do not predict the recovery of ERPF after release of obstruction. (4) Rapid reversal of a previously elevated RI is an early indicator of recoverability of renal function after relief of ureteral obstruction.

Animals↗
PubMed1997

Renal Doppler ultrasonography in children with equivocal obstructive uropathy: effect of intravenous normal saline fluid load and frusemide.

OBJECTIVE: To study the effect of hyperhydration with normal saline and frusemide on the renal resistive index (RI) in children with equivocal obstructive uropathy. PATIENTS AND METHODS: Twelve children (24 kidneys) with unilateral or bilateral hydronephrosis underwent isotopic diuretic renography and Doppler ultrasonography. All children had equivocal obstruction of the hydronephrotic kidneys with half-time drainage (T/2) values of 10-20 min. Doppler studies were carried out both at baseline and after the infusion of normal saline and frusemide. RESULTS: Of the 24 kidneys, five were normal and 19 were hydronephrotic; compared with normal kidneys, the hydronephrotic units had a significantly lower glomerular filtration rate (GFR) and longer T/2. At baseline, the mean RI values of normal and hydronephrotic kidneys were not significantly different (0.70, SD 0.03 and 0.71, SD 0.04, respectively). After the infusion of saline and frusemide, the mean RI of hydronephrotic kidneys (0.67, SD 0.07) was significantly (P = 0.01) higher than that of normal kidneys (0.60, SD 0.02), but the response of RI in hydronephrotic kidneys was variable. Based on the RI at baseline and after infusion, hydronephrotic kidneys could be categorized into three groups. Group 1 (n = 6) had an RI < 0.7 before and after infusion, group 2 (n = 6) had a baseline RI > 0.7 and < 0.7 after infusion, and in group 3 (n = 7) both RIs were > 0.7. Kidneys in group 3 had the lowest GFR and the highest T/2 values. Five of these seven hydronephrotic kidneys eventually had deteriorating GFRs requiring surgical correction; the GFR of the remaining hydronephrotic kidneys remained stable. CONCLUSION: In children with equivocal obstructive uropathy based on diuretic renography, the determination of RI before and after infusion of normal saline and frusemide could be helpful in distinguishing obstructed from non-obstructed kidneys.

Child↗
PubMed1997

Transurethral prostatectomy: a prospective randomized study of conventional resection and electrovaporization in benign prostatic hyperplasia.

OBJECTIVE: To compare transurethral electrovaporization of the prostate (TUVP) with conventional transurethral resection of the prostate (TURP) in the treatment of men with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Seventy consecutive patients with symptomatic BPH and a prostate size of < 60 g were prospectively randomized between equal treatment groups; one group underwent standard TURP and the other TUVP. Patients were assessed at baseline and 1, 3, 6 and 12 months after treatment, giving a mean (SD) duration of follow-up of 14.4 (1.9) months (range 12-17). Variables evaluated included the duration of operation, catheterization and hospital stay, and changes in blood levels of haemoglobin, haematocrit and sodium 1 h after the operation. The American Urologic Association (AUA)-7 symptom score, peak urinary flow rate (Qmax), post-voiding residual urine volume (PVR) and sexual function were also evaluated during the follow-up. RESULTS: Patients of both groups were balanced for the different baseline variables. The mean (SD) operative duration of TUVP was 52 (12.5) min, significantly longer than that of TURP, at 39.7 (8.8) min (P < 0.001). One hour after TURP, patients had significantly lower levels of haemoglobin, haematocrit and Na. The mean (SD) duration of catheterization after TURP was 2 (0.8) days, significantly more than after TUVP, at 1.1 (0.4) days (P < 0.001). The mean (SD) hospital stay was 2.5 (1) days after TURP and 1.5 (0.7) after TUVP (P < 0.001). Compared with baseline values, the AUA-7 symptom score, Qmax and PVR improved significantly in both groups at all intervals of follow-up and there were no significant differences between the groups during the follow-up. None of 15 potent men undergoing TURP and two of 18 potent men undergoing TUVP complained of impotence during the follow-up. CONCLUSIONS: TUVP is as effective as TURP in the treatment of BPH in men with a prostate size of < 60 g. TUVP has the advantages of less blood loss, less absorption of irrigant and a shorter hospital stay, but it had a significantly longer operative duration.

Aged↗
PubMed1997

Interposition of ileum in the ureter: a clinical study with long-term follow-up.

OBJECTIVE: To present the long-term results of the interposition of ileum in the ureter. PATIENTS AND METHODS: An ileal loop was interposed to replace a long defect of the upper ureter, with preservation of lower ureteric continuity, in nine patients (mean age 35 years, range 18-58). Patients were followed regularly for a mean of 5.2 years (range 2-7) and assessed using renal ultrasonography, isotopic renography and intravenous urography. RESULTS: Urinary drainage was satisfactory and renal function and configuration were improved. None of the patients experienced metabolic acidosis or electrolyte disturbances despite receiving no medication. CONCLUSION: These results were encouraging and further clinical experience is needed to confirm that ileal interposition of the ureter is a safe and effective procedure.

Adolescent↗
PubMed1997

Multiple but different urothelial tumours in one side of a urinary tract.

We present a combination of transitional cell carcinoma and a well differentiated squamous cell carcinoma in the right side of the urinary tract of a bilharzial patient. The right renal pelvis and the right ureter demonstrated transitional cell carcinoma, while the right lateral wall of the bladder showed squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed1996

Renal Doppler ultrasound in children with obstructive uropathy: effect of intravenous normal saline fluid load and furosemide.

PURPOSE: We studied the effect of hyperhydration with normal saline and furosemide on renal resistive index in children with obstructive uropathy. MATERIALS AND METHODS: 99mTechnetium-mercaptoacetyltriglycine diuretic renography and Doppler ultrasound were done in 27 children (54 renal units) with unilateral or bilateral hydronephrosis. Doppler studies were performed at baseline, and after infusion of normal saline and administration of furosemide. Half-time drainage, considered the gold standard for the diagnosis of renal obstruction, was compared to resistive index. RESULTS: There was a positive correlation between half-time and resistive index on both Doppler studies. With a resistive index of 0.70 as the critical value for predicting renal obstruction 82 versus 100% sensitivity (p < 0.006), 63 versus 94% specificity (p < 0.04) and 76 versus 98% overall accuracy (p < 0.0005) were obtained for Doppler studies at baseline and after induced diuresis, respectively. All children with false-positive results were younger than age 4 years. CONCLUSIONS: Doppler ultrasonography after hyperhydration with normal saline and furosemide is an accurate method for diagnosing renal obstruction in children. It is more sensitive, specific and accurate than baseline Doppler studies.

Child↗
PubMed1996

Renal Doppler ultrasound in children with normal upper urinary tracts: effect of fasting, hydration with normal saline, and furosemide administration.

OBJECTIVES: To study the age dependency of renal resistive index (RI) and to study the effect on the renal RI of fasting, intravenous infusion of normal saline, and administration of furosemide in children with normal upper urinary tracts. METHODS: The study included 28 nonobstructed renal units in 15 boys ranging in age from 3 to 11 years. Diuretic renography and Doppler ultrasonography were attempted in all children. Doppler ultrasonography was carried out under three different conditions: fasting state, 30 to 60 minutes after intravenous infusion of normal saline (15 mL/kg), and 10 minutes after administration of furosemide (1 mg/kg; maximum, 40 mg). RESULTS: There was an inverse correlation between age and RI of both renal units under the three conditions of Doppler studies. At fasting state mean RI was 0.70 +/- 0.04, whereas 15 of 28 renal units (54%) had an RI of 0.70 or higher. Intravenous infusion of normal saline significantly decreased the RI to 0.63 +/- 0.04 (P < 0.000001). Injection of furosemide caused a further significant decrease of RI from 0.63 +/- 0.04 to 0.60 +/- 0.04 (P < 0.002). CONCLUSIONS: The renal RI in healthy children is age dependent. In the fasting state, 54% of nonobstructed renal units in children have an RI of 0.70 or higher. Intravenous infusion of normal saline and administration of furosemide can independently cause a significant decrease of the RI in nonobstructed renal units in children.

Child↗
PubMed1996

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): an experimental study in dogs. II. Optimization of surgical technique.

OBJECTIVES: To optimize the surgical technique of the new extravesical seromuscular tunnel ureteroneocystostomy and to study the optimal relation between the length and width of the tunnel and the diameter of the normal and dilated ureters. METHODS: The optimized technique was applied to the left ureters of 20 dogs; 10 with normal ureters and 10 after induction of ureteral dilation. The new technique was performed to maintain a ratio of 3:1 between the width of the tunnel and the diameter of the ureter and a ratio of 1:1 between the length of the tunnel and the ureteral diameter. The results were compared with those for 5 dogs in which unilateral direct ureterovesical reimplantation was performed without an antireflux procedure. All the dogs were evaluated by intravenous urography, radioisotope renography, and ascending cystography before and at 1, 3, and 6 months after ureteroneocystostomy. RESULTS: All the dogs of the control group showed low-pressure vesicoureteral reflux and 3 demonstrated mild hydronephrosis and significant deterioration of the corresponding kidney. At 6-month follow-up, none of the 20 dogs subjected to the new technique showed deterioration of the function or configuration of the corresponding kidney. Moreover, the new technique was sufficient to prevent reflux in all but two dilated ureters that showed high-pressure vesicoureteral reflux. CONCLUSIONS: For the extravesical seromuscular tunnel to be effective in reflux prevention without obstruction, the width of the tunnel must be triple the diameter of the ureter, and the length of the tunnel covering the intact (nonspatulated) part of the ureter should be equal to its diameter.

Animals↗
PubMed1996

Partial ureteric obstruction: a study of Doppler ultrasonography and diuretic renography in different grades and durations of obstruction.

OBJECTIVES: To study the changes in renal resistive index (RI) and renal function with time during different grades of partial unilateral ureteric obstruction, and to determine the correlation between the ultrasonographic and renographic findings. MATERIALS AND METHODS: Ten dogs underwent right partial ureteric obstruction: grade 1 (mild) obstruction was applied in five dogs (group A) and grade 3 (moderate and severe) obstruction in the other five (group B). All dogs were assessed using excretory urography, diuretic renography with the calculation of half-time drainage (T 1/2) and bilateral renal Doppler ultrasonography before the experiment began, after one week of obstruction, and every 2 weeks during 8 weeks of obstruction. RESULTS: In both groups, after the induction of right ureteric obstruction, there was a progressive decrease of effective renal plasma flow (ERPF) and a progressive increase of the RI of the right kidney at the end of the first and second weeks of obstruction, with an almost stable value thereafter. The decrease of ERPF and the increase of RI in the right kidney were correlated with the degree of obstruction. There was also a dramatic increase of T 1/2 of the right kidney that correlated with the degree of obstruction. Concomitantly, there was a significant compensatory increase of ERPF and a significant decrease of the RI of the left kidney in both groups. The compensatory increase in CRPF limited the loss in total ERPF in both groups. The contribution of obstructed kidney to the total ERPF was significantly reduced in both groups. At the end of the eighth week, taking all kidneys together, there was a statistically significant negative correlation between the ERPF and RI, and between ERPF and T 1/2 and a positive correlation between T 1/2 and RI. CONCLUSIONS: Unilateral partial ureteric obstruction increased the RI and T 1/2 and decreased the ERPF of the corresponding kidney, together with a decrease of RI and an increase in ERPF of the contralateral kidney. The more severe the obstruction, the greater the increase in RI and T 1/2 and the decrease in ERPF. After the obstruction stabilized, RI and T 1/2 were positively correlated.

Animals↗
PubMed1996

Doppler ultrasonography in evaluation of potential live kidney donors: a prospective study.

PURPOSE: We compared the accuracy of Doppler ultrasonography and intra-arterial digital subtraction angiography for preoperative visualization of the number of renal arteries in potential live kidney donors. MATERIALS AND METHODS: Intra-arterial digital subtraction angiography and Doppler ultrasonography were used to study the renal anatomy of 64 consecutive kidney donors. Doppler studies were performed without knowledge of the angiographic findings. All donors underwent nephrectomy, and the number of renal arteries at nephrectomy was compared with that predicted by intra-arterial digital subtraction angiography and Doppler ultrasonography. RESULTS: One renal artery was found in 53 harvested kidneys, 2 in 10 and 3 in only 1. Analysis of the data revealed sensitivity 96.2% and specificity 100% for intra-arterial digital subtraction angiography versus sensitivity 100% and specificity 60% for Doppler ultrasound. Overall accuracy was 96.8% for angiography versus 93.7% for Doppler ultrasound, compared to 96.2 and 100%, respectively, for single, and 100% and 60%, respectively, for double renal arteries (p < 0.03). Both tests were interpreted as showing double vessels in the case with triple renal arteries. CONCLUSIONS: Although Doppler ultrasonography is accurate in delineation of single renal arteries, its limited ability to identify multiple arteries should make one cautiously optimistic regarding its current use.

Adult↗
PubMed1995

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): an experimental study in dogs. I. Preliminary results.

OBJECTIVES: To present the preliminary results of a novel technique of ureteroneocystostomy with a new principle (extravesical seromuscular tunnel). METHODS: The new technique was applied in the left ureter of 12 mongrel dogs. The dogs were stratified into three groups (4 dogs each) according to the length of the extravesical seromuscular tunnel. Tunnel lengths of 3, 2, and 1 cm were used for groups I, II, and III, respectively. All the dogs were evaluated by excretory urography, radioisotope renography, and ascending cystography before and at 2 weeks and 3 months after ureteroneocystostomy. Urodynamic evaluation by the Whitaker test and ureteral pressure profile were carried out at 3 months. RESULTS: None of the 12 dogs showed vesicoureteral reflux. All but 1 dog of group I and 2 dogs of group II showed evidence of ureteric obstruction. All 4 dogs of group III showed perfect configuration and function of the corresponding renal units at 2 weeks and 3 months after ureteroneocystostomy. Moreover, the intrapelvic pressure and the superimposed ureteral pressure of this group were approximately similar to pressures of the normal contralateral side. CONCLUSIONS: Preliminary results of this new technique of ureteroneocystostomy revealed that an extravesical seromuscular tunnel of 1 cm provides reflux prevention without obstruction.

Animals↗
PubMed1995

Partial ureteral obstruction: a new variable and reversible canine experimental model.

OBJECTIVES: To develop a new experimental model of partial ureteral obstruction that is simple, reliable, variable, and reversible. METHODS: A 6 F ureteral catheter was inserted into the left ureteral orifice and was cut 2 cm distal to the orifice. The most distal part of the ureter was ligated around the catheter. The catheter lumen was partially obstructed by insertion of stylets of three different diameters. The catheter and the stylet were fixed inside the bladder. The model was tested in 12 dogs, which were stratified into three groups according to the diameter of the obstructing stylet. All the dogs were subjected to intravenous urography (IVU) and technetium-99m-mercaptoacetyltriglycine (99mTc-MAG3) renal scan at 2 and 4 weeks following induction of partial ureteral obstruction. RESULTS: Three different grades of hydroureteronephrosis were obtained according to the diameter of the obstructing stylet. The IVU and 99mTc-MAG3 renal scan studies were repeated at 2 and 4 weeks following removal of the ureteral catheter and ureteroneocystostomy and showed marked improvement in the configuration and function of the corresponding renoureteral units. CONCLUSIONS: Our experimental model fulfills the requirements for a useful model of partial ureteral obstruction, namely, simplicity, reliability, variability, and reversibility.

Animals↗
PubMed1995

Late malignancy in bowel segments exposed to urine without fecal stream.

OBJECTIVES: This study was constructed so as to screen malignant transformation after uroenteric reconstructions using bowel segments exposed to urine without fecal stream for more than 10 years. METHODS: Follow-up data were available for 186 patients who underwent various uroenteric reconstructions using bowel segments exposed to urine without fecal stream for more than 10 years. There were 68 eligible patients with isolated rectosigmoid bladder, 23 with bladder augmentations (15 ileocystoplasty and 8 colocystoplasty), 57 with ileal ureter, and 38 with ileal loop conduit. Besides routine laboratory and radiologic investigations, urine for cytology was obtained from all patients. Moreover, endoscopy and random biopsy of the part of bowel exposed to urine were carried out in all patients. RESULTS: Uroenteric malignancy was diagnosed in 4 patients (2%): 2 adenocarcinoma in an isolated rectosigmoid bladder, 1 transitional cell carcinoma following augmentation colocystoplasty, and 1 squamous cell carcinoma after ileal ureter. None of the patients developed tumors in ileal loop conduits. CONCLUSIONS: Malignant changes do not only occur after ureterosigmoidostomy but are also observed after different uroenteric reconstructions not exposed to fecal stream. Hematuria, ureteral obstruction, and abnormal urine cytology are warning signs of malignancy. Routine cytology is recommended at least yearly beginning 10 years after surgery.

Adenocarcinoma↗
PubMed1995

Ethanol sclerotherapy for symptomatic simple renal cysts.

Twenty-eight patients with 30 symptomatic simple renal cysts were treated by percutaneous aspiration of the cyst and injection of 95% ethanol. All patients were available for follow-up during mean period of 19 (range 14-40) months. In all patients, successful resolution of the cyst with disappearance of the symptoms was observed within 1 month after treatment. During the whole period of follow-up, no patient experienced recurrence of symptoms or required repeat therapy. Of all renal cysts treated, resolution was complete in 25 (83%) and partial (recurrence of < 50% of original cyst volume with no symptoms) in 5 (17%). The degree of response to sclerotherapy (whether complete or partial) correlated significantly with cyst size (P > 0.0008). Major complications were not encountered, while microscopic hematuria was seen in two patients, and low-grade fever was observed in another two. Ethanol sclerotherapy is simple, noninvasive, and highly cost-effective and should be recommended for the treatment of symptomatic simple renal cysts.

Adult↗