PubMed Health⌕ Search

Biomedical subjects

M R Mahran

Publications and source records attributed to M R Mahran.

15 recordsLinked to original sources
PubMed2000

Renal colic in pregnant women: role of renal resistive index.

OBJECTIVES: To investigate the value of the renal resistive index (RI) in the identification of acute renal obstruction in pregnant women. METHODS: The study included 22 pregnant women with acute unilateral ureteral obstruction due to a stone disease (group A), 71 normotensive pregnant patients without loin pain (group B), and 20 nonpregnant women of child-bearing age with both kidneys normal (group C). All patients underwent Doppler ultrasound (DUS) with determination of the RI and the difference between the RI of the corresponding and contralateral kidney (DeltaRI). The RI and DeltaRI was considered positive for obstruction with a value of 0.70 or greater and 0.04 or greater, respectively. Ureteral obstruction was confirmed by several clinical, radiologic, and endoscopic findings. The sensitivity, specificity, and overall accuracy of RI and DeltaRI for the diagnosis of acute unilateral ureteral obstruction were calculated. RESULTS: In group A, kidneys with ureteral obstruction (n = 22) had a mean RI of 0.69 +/- 0.03; the contralateral normal kidneys (n = 22) had a mean RI of 0.63 +/- 0.03, a significant difference (P <0.0001). The mean RI of all kidneys in group B (n = 142) and all kidneys in group C (n = 40) was 0.64 +/- 0.05 and 0.62 +/- 0.04, respectively; the difference was not statistically significant. A comparison between the mean RI of the normal kidneys of group A and all the kidneys of groups B and C revealed no significant difference. The mean RI of the obstructed kidneys in group A was significantly higher than the mean RI of all the kidneys in groups B and C. Similarly, the mean DeltaRI of group A was significantly higher than the mean DeltaRI of groups B and C (0.06 +/- 0.01 versus 0.006 +/- 0.003 versus 0.006 +/- 0.004, respectively). The RI was sensitive in 45%, specific in 91%, and accurate in 87%. The corresponding values for DeltaRI were 95%, 100%, and 99%. CONCLUSIONS: The DeltaRI is a sensitive and specific test that can replace intravenous urography in the diagnosis of acute unilateral ureteral obstruction in pregnant women.

Acute Disease↗
PubMed2000

Cystolitholapaxy versus cystolithotomy in children.

BACKGROUND: Primary vesical stones are common in children in developing countries. Cystolithotomy is the traditional treatment, but a percutaneous approach has been advocated. PATIENTS AND METHODS: Between January 1992 and March 1997, 52 male children with primary vesical stones were treated at our center. The patients were stratified retrospectively into two groups according to the procedure of stone removal. Group I (25 patients) were children who underwent open cystolithotomy, and group II (27 patients) were those who had endourologic treatment either by the transurethral route (11 children) or via suprapubic approached (16). The mean age at the time of diagnosis was 3.6 +/- 2.1 years. The stone size ranged from 0.7 to 2 cm (mean 1.2 +/- 0.7 cm). RESULTS: In all cases, the stones were removed successfully. The operative time was similar in the two groups. The hospital stay was significantly less after endourologic procedures than after open surgery (P < 0.05). In Group I, one patient had a small-intestinal injury, and in Group II, one patient had urethral rupture and extravasation during transurethral cystolitholapaxy. There were no early or late complications in Group I. However, in Group II, 4 patients (15%) developed early and late complications. Early morbidity was in the form of persistent leakage of urine from the suprapubic site in one patient and acute abdomen from the peritoneal urine leakage in another two patients who had the same approach. A stricture of the bulbous urethra was seen in one patient 1 year after transurethral stone disintegration. CONCLUSION: In spite of the improvement of endourologic instruments, open surgical removal of primary vesical stones in boys is still the mainstay of therapy.

Child, Preschool↗
PubMed1999

Evaluation of the functional significance of the colorectal valve used in rectal urinary diversion in children: a comparative study between cases with and without the valve.

OBJECTIVES: To study the long-term impact of functional isolation of rectal reservoirs on the blood chemistries and acid-base balance of children who underwent this type of urinary diversion. METHODS: A retrospective evaluation of 63 children with rectal reservoirs was performed. Of these, 40 had a colorectal valve and 23 had double-folded rectal reservoirs without a functional isolation valve. Evaluation included serum chemistry and arterial blood sample analysis to verify the impact of the created valve on homeostasis. RESULTS: There was a statistically significant difference between the two groups relative to the value of pH, P(CO2), bicarbonate, base excess, and chloride in favor of those having a colorectal valve. Reduction of the absorptive surface area of the colon is presumably the cause in view of the functional isolation created by the colorectal valve. CONCLUSIONS: In children, the long life expectancy and the benign condition for which they have diversion require the incorporation of the colorectal valve in any form of continent rectal diversion. Prophylactic alkalinization with strict follow-up is a must in those having no valve.

Acid-Base Equilibrium↗
PubMed1999

A prospective randomized study comparing absorbable and nonabsorbable staples in constructing antireflux valves of urethral hemi-Kock pouches.

OBJECTIVE: To determine the long-term complications associated with constructing an antireflux nipple valve using absorbable or nonabsorbable staples in the urethral hemi-Kock pouch. PATIENTS AND METHODS: Fifty patients (all men, median age 47 years, range 28-73) undergoing construction of a urethral hemi-Kock pouch were randomized prospectively into two equal groups. In group 1, absorbable (polyglyconate) staples were used for the construction, and in group 2 nonabsorbable (metal) staples were used but omitting the staples applied at the tip of nipple valve. Assessment during the follow-up of 6-88 months comprised urine analysis, culture and sensitivity, measurement of serum creatinine, electrolytes and blood gases, and plain abdominal radiography, intravenous urography and micturating pouchography. RESULTS: In group 1, 21 patients were evaluable; a pouch stone was detected in one, extussusception of the valve in one and valve stenosis in one. In group 2, 20 patients were evaluable; pouch stones were detected in six, extussusception of the valve in three and valve stenosis in one. CONCLUSION: Compared with nonabsorbable (metal) staples, the use of absorbable (polyglyconate) staples significantly decreased the incidence of pouch stone formation and improved valve stability in patients with a urethral hemi-Kock pouch.

Adult↗
PubMed1999

A comparative study of the effects of a colorectal valve on the oro-anal transit time in patients with an augmented and valved rectum for urinary diversion.

OBJECTIVES: To evaluate the effect of the interposed colorectal valve on the flow of the proximal colonic contents to the rectum in patients with a valved urinary diversion to the rectum. PATIENTS AND METHODS: The oro-anal transit time (OATT) and segmental colonic transit time (SCTT) were estimated in two groups of 15 patients each (10 women and five men). In group 1, patients had a colorectal valve and in group 2 (control) they had no valve in the rectosigmoid area. The OATT and SCTT were evaluated using the 7-day method, whereby each patient swallowed 10 ring-shaped radio-opaque markers daily for 6 days, and a single abdominal radiograph was taken on day 7. The OATT and SCTT were then estimated as the number of retained markers divided by the daily dose of markers. RESULTS: The mean (sd) OATT was not significantly different (P=0.185), at 1.85 (1.21) days in group 1 and 2.49 (1.38) days in group 2. There were no sex differences in the values between the groups. The SCTT in the four areas of the colon again showed no significant differences within or between groups (P>0.05). CONCLUSION: Using a colorectal valve to functionally isolate the urinary rectal reservoir and thus reduce the high incidence of metabolic acidosis has no significant effect on intestinal transit times.

Adult↗
PubMed1994

The modified rectal bladder (the augmented and valved rectum) for urine diversion in children.

OBJECTIVES: Urinary diversion is usually the procedure of choice for children having complicated primary closure for bladder exstrophy. We introduce the modified rectal bladder as a low pressure and functionally isolated rectal reservoir as a bladder substitute for these cases. METHODS: Modified rectal bladder urinary diversion was done on 15 children as a low pressure and functionally isolated rectal reservoir via the adoption of sigmoid intussuscepted valve and the rectal patching with detubularized sheet of ileum. Fourteen of these children are currently evaluable, with follow-up ranging from 16 to 72 months (median 55 months). All of them are subjected to thorough history-taking, clinical examination, laboratory and radiologic investigations, and urodynamic study. RESULTS: A high rate of urinary continence was achieved and so far the upper urinary tract and the metabolic status were preserved. Reflux to the colon and kidneys was prevented. Urine samples from the renal pelvis through percutaneous needle aspiration revealed sterile cultures in 82% of the renal units (23 of 28). CONCLUSIONS: Our results demonstrate the distinct advantages of the modified rectal bladder over the conventional methods of urinary diversion to the rectum or the abdominal reservoirs coupled to the skin via continent catheterizable stomas.

Bladder Exstrophy↗
PubMed1994

The application of the modified rectal bladder in management of the compromized urethral damage.

Failure to repair the traumatic injuries of the lower urinary tract with loss of urethral sphincteric function usually puts forward the subject of urinary diversion. Ten males and five females presented with extensive urethral damage and with or without vesical fistulas. All attempts of repair were exhausted before the decision of diversion was planned. Continent urinary diversion using the modified rectal bladder (the augmented and valved rectum) was utilized. The procedure entailed functional isolation of the rectum without terminal colostomy and depended on colorectal intussuscepted valve. All the patients are currently evaluated with follow up periods ranging 10-56 months. Evidences proved the effectiveness of the colorectal valve in providing non impeded fecal stream to the functionally isolated rectal reservoir. Continent status is attributed to the ileal patching that produces a low pressure reservoir against the effective high anal resistance. The results support the distinct superiority of the modified rectal bladder to either the conventional methods of urinary diversion to the rectum or the abdominal reservoir with continent catheterizable stomas.

Adolescent↗
PubMed1993

Interposition of ileum in the ureter.

An ileal loop was interposed to replace a long defect of the upper ureter with preservation of the lower ureteral continuity in three patients. Urinary drainage was satisfactory and at follow-up 2-4 years postoperatively renal function was improved.

Adult↗
PubMed1993

Verrucous carcinoma of the bilharzial bladder. Impact of invasiveness on survival.

Verrucous carcinoma of bilharzial bladder, a rare neoplasm, is regarded as a distinct variant of squamous cell carcinoma. We studied 37 cases treated with cystectomy in the past 15 years. Despite previous reports of no local invasion and no local recurrence or distant metastasis postoperatively, we observed 60% of focal tumour transformation into invasive squamous cell carcinoma. Such transformation and dedifferentiation to squamous cell carcinoma can be expected in a high proportion of these tumours. The survival rate in the invasive cases was approximately the same as in squamous cell carcinoma. Non-surgical management or adjuvant treatment to surgery are inappropriate in verrucous bladder carcinoma. Radical cystectomy is the only standard treatment offering cure.

Adult↗
PubMed1992

Further experience with the urethral Kock pouch.

In 185 men a urethral Kock pouch was constructed as a bladder substitute after radical cystectomy for cancer. A total of 117 patients was followed for a minimum of 1 year and is fully evaluable. Of the patients 108 (92%) are completely continent during the day, while 85 (73%) are dry at night. Also, 8 patients had an excellent response to imipramine hydrochloride. Stability or improvement in the configuration of the upper tract was noted in 210 renal units (90%). A total of 24 renal units showed evidence of deterioration due to reflux (16) and an anastomotic stricture (8). Stability of the antireflux nipple valve was ensured by creation of a window in the mesentery of the corresponding bowel segment and by anchoring the valve to the wall of the pouch by an additional row of staples. On the basis of this favorable outcome the procedure is recommended for male patients for whom cystectomy is indicated and in whom the urethra can be preserved.

Cystectomy↗
PubMed1992

Further experience with the modified rectal bladder (the augmented and valved rectum) for urine diversion.

Continent diversion with the modified rectal bladder was done in 83 patients and 65 are currently evaluable with followup ranging from 6 to 36 months. There was no postoperative mortality and the morbidity rate was acceptable. Renal function and configuration were maintained in most patients (91%). Dessusception of the colorectal valve was observed in 7.6% of the patients. Evidence was provided that this valve is effective in prevention of regurgitation of the rectal contents to the proximal colon. All patients were continent during the day. Enuresis was noted in 6 patients and all of them responded to imipramine hydrochloride therapy. The results support earlier observations that the procedure offers distinct advantages over ureterosigmoidostomy and the simple rectal bladder.

Adult↗
PubMed1989

Replacement of the bladder by the urethral Kock pouch: functional results, urodynamics and radiological features.

After cystoprostatectomy for cancer of the bladder 43 men were provided with a detubularized, low pressure ileal reservoir (Kock pouch) connected to the urethra. Reflux was prevented by an intussusception valve. There was no operative mortality and few early complications. At followup the mean postoperative observation time was 13 months, with a range of 5 to 20 months. Late complications included manifestations of local tumor recurrence or distant metastases in 9 patients within 6 months postoperatively, which made adequate functional evaluation impossible. In 18 patients reflux to the upper urinary tract due to eversion or sliding of the antireflux valve occurred at various postoperative intervals. In 16 of these patients incontinence developed as a consequence of the reflux. Surgical correction of the failing antireflux valve restored reflux prevention and continence. Within 3 to 6 months the capacity of the reservoirs had reached an ultimate volume of approximately 600 ml. Pressure waves exceeding 40 cm. water seldom occurred in the mature reservoirs and then only at high filling volumes. The mean urethral resting resistance to flow was 64 cm. water. The configuration and function of the upper urinary tract improved or stabilized postoperatively. Of 34 evaluable patients 30 were continent during the day with a voiding frequency of 3 to 5 times and dry at night with a frequency of 0 to 2.

Adult↗
PubMed1988

Urinary diversion to the augmented and valved rectum: preliminary results with a novel surgical procedure.

A new method for urinary diversion to the rectum was elaborated in animal experiments and currently has been used in 19 patients. Reflux of the rectal content to the colon and to the upper urinary tract is prevented by the fashioning of an intussusception valve at the rectosigmoid junction. The rectum is augmented by anastomosing an ileal patch to the anterior rectal wall. A transverse colostomy protects the construction for 6 to 8 weeks. Of the 19 patients 3 had local recurrence or metastasis within 6 months. Thus, 16 patients with a followup of 3 to 14 months are evaluable. All patients are continent during the daytime with an emptying frequency of 3 to 5 times and dry at night with a frequency of 0 to 2. In 3 patients partial sliding of the sigmoid intussusception valve occurred causing reflux of rectal contents to the sigmoid and to the right ureter in 1. Reflux to the upper urinary tract has not been revealed in any of the other patients. With 1 exception excretory urography has demonstrated either improvement or stabilization of the upper urinary tract post-operatively. The rectal capacity increased from 200 to 700 ml. after 6 months. With the reservoir full the mean basal pressure was 17 cm. water and the mean maximum pressure was 24 cm. water.

Adult↗