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H Sibai

Publications and source records attributed to H Sibai.

6 recordsLinked to original sources
PubMed2001

Hydronephrosis with diffuse or segmental cortical thinning: impact on renal function.

PURPOSE: Management of hydronephrosis has changed considerably with the routine use of prenatal ultrasonography. Increased dependence is now placed on nuclear renographic differential renal function, and many urologists consider surgical intervention for ureteropelvic junction obstruction with significant decrease in renal function (less than 40%). Correlation between differential renal function and the degree of dilatation diagnosed by ultrasound has not been reported. In addition, no difference between hydronephrosis associated with either diffuse or segmental cortical thinning has been made, as both are classified as grade IV according to the Society of Fetal Urology classification. Based on clinical observation we hypothesized that hydronephrotic grade IV kidneys with diffuse parenchymal thinning are associated with worse renal function and are distinct from those with segmental cortical thinning. MATERIALS AND METHODS: We performed a retrospective study of patients who underwent pyeloplasty between January 1996 and December 1998. Hydronephrosis was graded according to Society for Fetal Urology classification and all diuretic renograms were performed in a standardized fashion. Grade IV kidneys were divided into IVA (segmental cortical thinning) and IVB (diffuse cortical thinning). Statistical correlation of grade and differential renal function was performed using a chi-square test. RESULTS: Images were available for review in 77 patients. Average patient age at intervention was 20.4 months and 7.6 years of the prenatally and postnatally detected hydronephrosis groups, respectively. Of the 77 cases 25 had grade IVA and 18 had grade IVB hydronephrosis. Of the grade IVB hydronephrosis cases 66% had less than 40% differential renal function compared to 24% in group IVA (p <0.05). CONCLUSIONS: Patients with grade IVB hydronephrosis secondary to ureteropelvic junction obstruction have a higher risk of significant decrease in renal function. Group IVA has significantly better function than group IVB and characteristics similar to grade III hydronephrosis cases. Grade IVB hydronephrosis should monitorized closely as earlier intervention may be warranted to avoid progressive deterioration of renal function.

Female↗
PubMed2001

Bladder exstrophy associated with complete urethral duplication: a rare malformation with excellent prognosis.

PURPOSE: We report the association of complete urethral duplication and bladder exstrophy in 5 males, and describe the main characteristics to achieve diagnosis. MATERIALS AND METHODS: From 1983 to 2000, 5 males with single bladder exstrophy and complete urethral duplication were seen at 3 institutions. Although bladder exstrophy was obvious at birth, only 1 patient had the preoperative diagnosis of associated urethral duplication. All patients were evaluated with abdominal ultrasound, voiding cystourethrogram after bladder closure and cystoscopy. RESULTS: All patients were totally incontinent, including 4 after primary bladder exstrophy closure. Although it was initially unnoticed by the urologist, most patients had leakage from the tip of the penis during the Valsalva maneuver. In all cases bladder exstrophy was single and deeply situated in the pelvis with excellent elasticity. All patients had a normal sized penis with less severe dorsal chordee and conical shaped glans. The duplicate epispadiac urethra did not have a verumontanum. Only 1 of the 5 patients had the correct diagnosis made before primary closure of bladder exstrophy, while in the other 4 diagnosis of a duplicate ventral urethra was made at the time of epispadias or fistula repair. There were no other associated malformations. In all cases the dorsal epispadiac urethral plate was excised and bladder emptying occurred through the ventral urethra, which at cystoscopy had a normal verumontanum. Postoperatively, all patients became continent and voided with good flow through the ventral urethra and, as opposed to many cases of exstrophy and epispadias, had normal size and excellent cosmesis of the penis. CONCLUSIONS: Complete urethral duplication is a rare variant of the exstrophy-epispadias complex. Patients with this anomaly present with a larger and more deeply situated bladder plate than classical exstrophy and a larger penis. A high index of suspicion is necessary to make a preoperative diagnosis. Excision of the dorsal urethral plate and maintenance of the ventral urethra are the treatment of choice, resulting in a continence and normal voiding.

Adult↗
PubMed2000

Urethral duplication in the male: review of 16 cases.

PURPOSE: Urethral duplication is a rare congenital anomaly. The clinical presentation varies because of the different anatomical patterns of this abnormality. We describe our experience with 16 male patients with this anomaly. MATERIALS AND METHODS: We retrospectively reviewed the records of 16 male patients treated for urethral duplication in the last 10 years. Age at presentation ranged from newborn to 8 years. Evaluation included ultrasound, voiding cystourethrography, retrograde urethrography and endoscopy. RESULTS: A blind ending duplicated urethra (type I) was present in 4 patients, 2 independent urethras with distinct bladder necks (type IIA1) in 6, 2 urethras originating from a common bladder neck (type IIA2) in 4, and complete urethral and bladder duplication (type III) in 2. Six patients had associated vesicoureteral reflux. Duplication was an incidental finding at epispadias repair in 3 patients with bladder exstrophy, at hypospadias repair in 1 and at hydrocele repair in 1. One patient with bilateral dysplastic kidneys died in the newborn period. Surgical management included excision of the duplicated urethra in 8 cases and urethroplasty using a pedicle flap in 2, while surgical management was not required in 3. CONCLUSIONS: Urethral duplication is a rare congenital anomaly with a variable clinical presentation. This pathological condition may easily be under diagnosed, especially in patients with other associated anomalies, such as hypospadias or bladder exstrophy. Surgical management should be planned individually according to the anatomical findings of the abnormality.

Child↗
PubMed1997

[Primary muscular echinococcosis. Apropos of 2 cases].

We report 2 cases of primary muscular hydatosis of the thigh in a 30-year-woman and a 75-year-man. The clinical picture was a benign soft tissue tumor. The ultrasound and C.T. scan exams confirmed the diagnosis and showed precisely the intimacy of the lesion with the femoral vascular axe. Preoperative diagnosis of this affection is mandatory in order to prevent any rupture of the cyst so as to avoid anaphylactic shock and local recurrence. Percystectomy is the treatment of choice for this lesion.

Adult↗
PubMed1996

Prolonged intrauterine transabdominal ventricular external drainage. A method to decompress dilated fetal ventricles.

Advances in diagnostic procedures to detect intrauterine hydrocephalus have compelled neurosurgeons to intervene in order to preserve precious neural tissue. We present the first case (to the best of our knowledge) of a successful decrease in intracranial pressure and head circumference by repeated transabdominal intrauterine external drainage. The mother tolerated the procedure well. No complication occurred from the procedure. This method may temporarily decrease the intracranial pressure and head circumference in utero, preserve neural tissue and facilitate normal vaginal delivery. The literature of intrauterine intervention in hydrocephalic fetuses is reviewed.

Cerebral Ventricles↗