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Mamdouh M Koraitim

Publications and source records attributed to Mamdouh M Koraitim.

4 recordsLinked to original sources
PubMed2005

On the art of anastomotic posterior urethroplasty: a 27-year experience.

PURPOSE: We determined the various operative details of anastomotic posterior urethroplasty that are essential for a successful result. MATERIALS AND METHODS: We reviewed the medical records of 155 patients who had undergone anastomotic repair of posterior urethral strictures or distraction defects between 1977 and 2003. Patient age ranged from 3 to 58 years (mean 21) and all except 1 had sustained a pelvic fracture urethral injury as the initial causative trauma. Repair was performed with a perineal procedure in 113 patients, elaborated perineal in 2 and perineo-abdominal in 40. Followup ranged from 1 to 22 years. RESULTS: The results were successful in 104 (90%) cases after perineal (including 2 elaborated perineal) and in 39 (98%) after perineo-abdominal repair. Successful results were sustained for up to 22 years after surgery. Urinary incontinence did not develop in any patients while 2 lost potency as a direct result of anastomotic surgery. CONCLUSIONS: Of the operative details 3 constitute the gold triad that assures a successful outcome, namely complete excision of scarred tissues, fixation of healthy mucosa of the 2 urethral ends and creation of a tension-free anastomosis. When the bulboprostatic urethral gap is 2.5 cm or less, restoration of urethral continuity may be accomplished with a perineal procedure after liberal mobilization of the bulbar urethra. For defects of 2.5 cm or greater the elaborated perineal or perineo-abdominal transpubic procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely (2%) to urethroplasty itself.

Adolescent↗
PubMed2004

Post-traumatic posterior urethral strictures: preoperative decision making.

OBJECTIVES: To assess the reliability of certain preoperative findings in helping select the correct operation for post-traumatic posterior urethral strictures and distraction defects. METHODS: We reviewed all urethrography and endoscopy studies of 167 posterior urethral strictures and distraction defects complicating pelvic fracture urethral injury that had been corrected between 1977 and 2002. Correction was by anastomotic urethroplasty in 149 cases (107 perineal, 2 elaborated perineal, 40 perineo-abdominal), scroto-urethral inlay in 2, and optical urethrotomy in 16. The findings were correlated with those encountered during surgery. RESULTS: Successful results after optical urethrotomy were encountered only in cases of genuine urethral stricture with no loss of urethral continuity. Anastomotic urethroplasty could be accomplished by an ordinary perineal procedure when the length of the distraction defect was 3 cm or less and only by an elaborated perineal or a perineo-abdominal procedure when it was 3 cm or more. The 2 cases that were corrected by scrotal inlay had an extensively scarred anterior urethra that precluded urethral anastomosis. CONCLUSIONS: A genuine stricture may indicate optical urethrotomy, but a distraction defect indicates anastomotic urethroplasty. Defects shorter than 3 cm may be corrected by an ordinary perineal anastomosis, while defects longer than 3 cm usually need an elaborated perineal or perineo-abdominal procedure. The finding of a scarred anterior urethra usually precludes urethral anastomosis and dictates substitution urethroplasty.

Adolescent↗
PubMed2003

Failed posterior urethroplasty: lessons learned.

OBJECTIVES: To determine the factors contributing to unsuccessful results after posterior urethroplasty and to establish some guidelines for its prevention. METHODS: From 1977 through 2000, 130 patients (3 to 58 years old) underwent 145 anastomotic urethroplasty procedures for post-traumatic posterior urethral distraction defects. Bulbo-prostatic anastomosis was performed through the perineum in 105 cases and by a perineo-abdominal transpubic procedure in 40. Factors that might have an impact on the surgical result, such as the size and type of sutures, urethral stents, and use of antibiotics were standardized. The records of all patients with unsuccessful results during a follow-up of 2 to 20 years were analyzed. RESULTS: Overall, the results were unsuccessful in 12 cases (8%). A negative result was related to incomplete excision of the scar tissue in 3 cases, inadequate fixation of the prostatic mucosa in 6 cases, and anastomotic tension in 2 cases; 1 patient was lost to follow-up. Previous repair, length of distraction defect, and urinary infection had no statistically significant influence on the result. CONCLUSIONS: The essential operative details of posterior urethroplasty include complete excision of scar tissue involving the membrano-prostatic region, lateral fixation of pliable prostatic mucosa, and creation of a tension-free anastomosis. If a tension-free anastomosis cannot be achieved through the perineum, the perineo-abdominal progressive approach or the elaborated perineal technique should be used at the same setting. Previous repair, a long distraction defect, and urinary infection do not preclude successful posterior urethroplasty.

Adolescent↗