Biomedical subjects

Mohsen Ayed

Publications and source records attributed to Mohsen Ayed.

15 recordsLinked to original sources

PubMed2006

Prognostic factors of recurrence after vesicovaginal fistula repair.

PURPOSE: We evaluate the prognostic factors of recurrence in patients after the surgical repair of vesicovaginal fistula. MATERIALS AND METHODS: From 1985 to 2002, 73 women with vesicovaginal fistula underwent late (> 3 months) surgical repair. A multivariate analysis of the data was performed with the EPI-INFO software. All P-values were two-sided, with odds ratio and 95% confidence intervals. RESULTS: A total number of 73 patients underwent 97 procedures with a mean rate of 1.38 procedures/patient. The overall surgical success rate was 86.7%. Multivariate analysis demonstrated that recurrence was statistically significant for multiple fistulas (single vs two or more), fistula size (>10 mm), fistula type (Type I vs Type II), fistula etiology (obstetrical vs non-obstetrical) and the presence of urinary tract infection before the repair. Recurrence risk was fivefold higher for both the size and the type of the fistula, threefold higher for obstetrical etiology and 4.5-fold higher for multiple fistula. The interposition of flaps was a protective factor for recurrent cases. The surgical approach was not a significant prognostic factor of recurrence. CONCLUSION: Successful closure of a vesicovaginal fistula requires an accurate and a timely repair using procedures that exploit basic surgical principles. Multiple fistula, size and type of the fistula, and obstetrical etiology were the recurrence risk factors. We recommend in all patients with multiple risk factors for recurrence, the interposition of flaps.

Adult↗

PubMed2006

[Inverted papilloma of the bladder: diagnosis and course].

OBJECTIVE: To analyse the diagnosis, treatment and clinical course of inverted papilloma of the bladder MATERIALS AND METHODS: Between January 1980 and January 2004, 12 patients with an inverted papilloma of the bladder were included, representing 0.36% of all bladder tumours treated over the same period. RESULTS: This series consisted of 10 men and 2 women with a mean age of 62 years (range: 42-83 years). The most frequent presenting complaint was macroscopic haematuria (10/12 cases), associated with signs of bladder irritation in 8 cases. This lesion was solitary and frequently located in the trigone (7/12 cases). An associated transitional cell carcinoma was diagnosed in 5 cases. CONCLUSION: Inverted papillomas of the bladder are rare, benign tumours that can be associated with urothelial carcinoma, requiring rigorous surveillance.

Adult↗

PubMed2006

[Post traumatic rupture in patients with uretero pelvic junction obstruction. Case report].

Authors report a case of post traumatic pelvic rupture occurring in an unknown ureteropelvic junction (UPJ) obstruction. Ultrasonography showed pyelectasia and fluid effusion in the anterior perirenal space. CT scan confirmed the diagnosis of UPJ obstruction and showed the rupture of the anterior pelvic wall communicating with a perirenal urinoma. The patient underwent a retrograde stenting for decompression and surgical drainage of the urinoma. Pyeloplasty was performed 4 months after injury. A follow up intravenous pyelogram showed good flow through the repair and the patient remaines asymptomatic 2 years after treatment. Post traumatic rupture of UPJ obstruction is a rare event with few reported cases in literature. Diagnosis is suggested on imaging studies. CT scan shows the rupture site in the ureteropelvic tract and guides percutaneous drainage.

Adult↗

PubMed2006

[Surgical treatment of post-traumatic complete urethral rupture: deferred urgent urethral suture or delayed repair?].

OBJECTIVE: To compare the results of deferred urgent surgical treatment and delayed repair in post-traumatic complete urethral rupture. PATIENTS AND METHOD: Between 1986 and 2003, sixty patients were operated for complete rupture of the posterior urethra. In the absence of any serious visceral or skeletal lesions, 32 patients were operated within five to ten days (Group I). In 28 cases (Group II), patients were operated 8 months after the injury via a perineo-transsymphyseal approach. RESULTS: The mean age of these patients was 28 years (range: 18 to 53 years). With a minimum follow-up of 2 years (range: 2-14 years), the urine stream was considered to be satisfactory in 90% of patients of group I and in 100% of cases of group II. Continence was perfect in 91% of patients in the two groups. Erectile dysfunction was observed in 22% of cases of Group I versus 28.5% of cases of Group II. CONCLUSION: Deferred urgent end-to-end urethral suture and delayed urethroplasty give globally comparable results. Deferred urgent end-to-end urethral suture must be performed whenever possible. The perineo-transsymphyseal approach must be reserved to the treatment of large stenoses in multi-operated or delayed repair patients.

Adolescent↗

PubMed2005

[Emphysematous pyelonephritis. Two cases].

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.

Anti-Bacterial Agents↗

PubMed2005

[Primary transitional cell carcinoma of the bulbar urethra].

The authors report a case of low-grade primary papillary transitional cell carcinoma of the bulbar urethra in a 61-year-old man treated by endoscopic resection with a favourable outcome and no recurrence with a follow-up of 11 years.

Carcinoma, Transitional Cell↗

PubMed2005

[Prognostic value of clinicopathologic factors in superficial bladder tumors: a retrospective analysis].

OBJECTIVE: To study, through a series of superficial bladder tumors, the prognostic factors of recurrence and tumoral progression. MATERIALS AND METHODS: This is a retrospective study of a series of 59 urothelial tumors of the bladder at stage pTa or pT1. The following parameters were considered: age, sex, treatment, stage and grade. The chi square test was used in search of a correlation between the different parameters and the course (recurrence and progress) of the disease. A multivariate analysis was undertaken by integrating factors correlated with the course. RESULTS: Thirty two tumors (54 %) had recured versus 27 (46%) without recurrence. Eight tumors (25 %) progressed in grade and 4 (12,5 %) had become infiltrative. Age beyond 65 years, tumoral size > 3 cm and multifocality were predictive factors of recurrence with a relative risks of 2,36, 3,28 and 3,88 respectively. In a multivariate analysis, these factors remained significant with adjusted relatif risks respectively of 1,36, 1,6 and 1,7.

Adult↗

PubMed2005

[Ureterocalicostomy: last resort in the treatment of certain forms of ureteropelvic junction stenosis. Report of 5 cases].

INTRODUCTION: Iatrogenic stenoses of the ureteropelvic junction are now essentially treated by endoscopic techniques. However, conventional surgery is sometimes required to treat severe or extensive stenosis. The authors report the use of ureterocalicostomy to treat 5 patients with complex lesions. MATERIAL AND METHODS: Between 2001 and 2003, the authors treated five patients with iatrogenic stenosis of the ureteropelvic junction. Two of these patients had a history of percutaneous nephrolithotomy and the other three had undergone conventional pyelotomy, complicated by pyelocaliceal avulsion in one case. The diagnosis was confirmed by double anterograde and retrograde opacification in four patients and intravenous urography in one patient. It was decided to perform ureterocalicostomy due to the extent of the lesions. Inferior ureterocalicostomy was performed after lower pole nephrectomy in all cases. RESULTS: The mean follow-up was 21 months (range: 20 to 27 months). Three patients had an uneventful postoperative course and satisfactory radiological follow-up. One patient rapidly developed stenosis that was treated successfully by endoscopy and another patient obtained a poor result requiring nephrectomy. CONCLUSION: Ureterocalicostomy requires laborious surgical dissection and meticulous ureterocaliceal anastomosis, but it is a useful technique in some cases of severe and extensive iatrogenic stenosis of the ureteropelvic junction.

Adult↗

PubMed2003

[Treatment of ureteral stones by ESWL. Indications and results in 201 cases].

OBJECTIVE: To evaluate the results of treatment of ureteric stones by ESWL as a function of various parameters, size, site and number of stones treated, in order to more precisely define the indications and consequently improve our results. MATERIAL AND METHODS: This study was based on 201 patients treated by ESWL for ureteric stones. The stones were situated in the lumbar ureter in 151 cases (73.6%) and in the pelvic ureter in 50 cases (26.4%). The size of the treated stones was less than 1 cm in 63.6% of cases and between 1 and 2 cm in 36.4% of cases. Treatment was performed by a Chinese hydroelectric lithotriptor with fluoroscopic and ultrasonographic detection, the ZM III. RESULTS: The results of treatment were not influenced by the site (lumbar or pelvic) of the stone and a good result (fragmentation and complete elimination of the stone) was obtained in 67.6% of cases. However, the difference of the results according to the size of the stone was statistically significant (p < 0.05), with a good result in 75.6% of cases when the stone diameter was less than 1 cm and 55.5% of cases when the stone diameter was greater than 1 cm. CONCLUSION: ESWL remains the first-line treatment for ureteric stones regardless of their site with better results for radiopaque stones less than 1 cm in diameter. An endoscopic procedure (double J stent) can be proposed before ESWL in some cases, such as solitary kidney or large stones, to decrease the complications.

Humans↗

PubMed2003

[Prostatic cancer in the young adult].

Prostatic carcinoma is exceptional in young adults before the age of 30. It is often diagnosed at a late, clinically advanced stage with a poorly differentiated histological type. Treatment is usually palliative and the prognosis is very poor with a mean survival of 6 months. The authors report a new case in a 25-year-old patient with locally advanced poorly differentiated prostatic carcinoma and a Gleason score of 10 treated by endocrine therapy, radiotherapy and chemotherapy with a good clinical and radiological course with a follow-up of two years.

Adenocarcinoma↗

PubMed2003

[Attitude of health personnel to organ donation and transplantation].

It was shown that the rate of organ donation depends not only on the attitudes of the public but also of the predisposition of the health care staff. An opinion poll has interested 702 physicians, nurses and technicians. It comes out from this study that 59% of the sample are favorable to the organ donation. The reason of the most quoted acceptance is "humane reason" (46%). Concerning the refusal of the organ donation by the professionals of health, 3 reasons are held: (i) religious reserves (26.4%), (ii) without reasons (22.8%) and (iii) personal reasons (20.9%). For approximately 10% of the doctors the refusal is ethical. In conclusion, the Tunisian physicians adopt an attitude favorable to the organ donation, whereas nurses and technicians are rather reticent. Refusal reasons identified during this study could direct the organizers of the public awareness campaigns for the promotion of organs donation.

Adult↗

PubMed2002

[Genito-urinary malacoplakia. Report of 10 cases and review of the literature].

The malakoplakia is a rare and benign disease. Its urinary localisation is commonly known. It has no clinical particularity. The diagnosis is histological. The physiopathology is infectious associated with a local macrophage function failure. The treatment associates antibiotic and colinergic drugs. Surgical removal is necessary only when the organ is destroyed. We report 10 cases of urinary malakoplakia with 4 renal localisation's causing pyonephrosis in the majority of cases, 3 prostatic localisation's that were wrongly considered as prostatic adénocarcinoma after a rectal examination and finally 3 testicular localisation's causing a necrotic destruction of the testis. The urinalysis was positive in 4 cases. We did 4 kidney removals, 3 endoscopic prostatic resections and 3 testis removals. The diagnosis was made by the histological examination of the surgical products.

Adolescent↗

PubMed2002

[Intrathoracic kidney due to diaphragmatic hernia: a case report].

The authors report a case of incidental discovery of a right intrathoracic kidney in a 70-year-old man, in July 1994, on intravenous urography performed for assessment of benign prostatic hyperplasia. This intrathoracic ectopic kidney is due to a diaphragmatic hernia and may be either congenital or acquired. It must be distinguished from true ectopic kidney, present during foetal life [4], which requires a high origin of the renal artery from the aorta with elongation of the ureter. Intrathoracic kidney due to diaphragmatic hernia is usually asymptomatic, but may be responsible for severe clinical symptoms with respiratory distress occurring in a newborn infant with this malformation. The diagnosis of intrathoracic kidney must be considered in the presence of a mediastinal mass on chest x-ray and is confirmed by intravenous urography, or even thoracic computed tomography. Apart from its rare complications, this anomaly does not require any specific treatment.

Adenoma↗

PubMed2002

[The vesico-acetabular fistula].

We report the first case of a vesico-acetabular fistula observed with a septic arthritis of the left hip late treated in a 22-year-old man. The treatment of this fistula is surgical.

Acetabulum↗

PubMed2002

[Impact of the use of double J stents in renal transplantation on incidence of urologic complications and urinary infection].

OBJECTIVE: The authors evaluated the impact of systematic placement of a double J stent on urological complications and postoperative urinary tract infection. MATERIAL AND METHODS: 188 renal transplantations were performed between January 1991 and December 2001. All patients underwent Lich-Grégoire ureterovesical anastomosis. A double J stent was not used in one group (G1) of 110 patients and a double J stent was systematically inserted in another group (G2) of 78 patients and was removed after 3 weeks. Urine culture was performed in all patients. RESULTS: 11 patients of group 1 developed urinary fistula and one patient developed obstruction of the ureterovesical anastomosis. No urological complication was detected in group 2. The postoperative urinary tract infection rate was 47.2% in group 1 versus 48.7% in group 2. CONCLUSION: Systematic double J stenting appears to decrease the incidence of urological complications after renal transplantation without increasing the incidence of postoperative urinary tract infection.

Adult↗