Biomedical subjects

Mostafa M Elhilali

Publications and source records attributed to Mostafa M Elhilali.

15 recordsLinked to original sources

PubMed2006

Laser treatment of symptomatic benign prostatic hyperplasia.

The treatment of lower urinary symptoms secondary to benign prostatic hyperplasia (BPH) after failure of medical therapies remains controversial for most urologic surgeons. The complications of traditional surgery are the driving force behind the development of several minimally invasive treatments of symptomatic BPH. Laser prostatectomy is one of the most investigated such modalities. In this article we reviewed the results of the most common types of lasers used in prostatic surgery.

Humans↗

PubMed2006

Alfuzosin: an alpha1-receptor blocker for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia.

Alpha1-receptor blockers have become first-line therapy for the medical management of lower urinary tract symptoms associated with benign prostatic hyperplasia. However, adverse effects such as cardiovascular intolerance can limit their use. This article focuses on alfuzosin, a clinically uroselective, alpha1-adrenergic antagonist that is available as a novel once-daily formulation that does not require dose titration. Alfuzosin is less vasoactive than other non-subtype selective alpha1-receptor blockers. In addition to effects on lower urinary tract symptoms, it is also used as an adjunct to urethral catheterisation in patients with acute urinary retention related to benign prostatic hyperplasia, and can improve sexual function and health-related quality of life in benign prostatic hyperplasia sufferers.

Adrenergic alpha-1 Receptor Antagonists↗

PubMed2005

Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy.

OBJECTIVE: To evaluate HoLEP for patients with enlarged prostate (traditionally treated by open prostatectomy) with long-term follow-up. METHODS: A retrospective analysis of 225 consecutive patients presenting with lower urinary symptoms secondary to benign prostatic hyperplasia with large prostate (>80 cc) who underwent HoLEP. Enucleation time, morcellation time, enucleated tissue weight, catheterization time, hospital stay, voiding outcome parameters, and complications were recorded. RESULTS: Mean preoperative prostate volume was 126+/-45.1 cc (range 80-351, median 111.2 cc), and resected tissue weight was 86.5 g. Mean follow-up was 31+/-12 months (median 24 months). Mean catheter time and hospital stay were 1.3 and 1.2 days, respectively. Patient symptom scores and peak flow rates were significantly improved immediately after surgery and continued to improve during subsequent follow up. Two patients required intraoperative blood transfusion, and a third patient needed blood transfusion in the early postoperative period for persistent hematuria. Bladder neck contracture and urethral stricture developed in 0.4% and 1.3%, respectively. CONCLUSIONS: HoLEP represents a safe and effective treatment for patients with symptomatic large prostates. It offers patients who traditionally required open prostatectomy the alternative of being treated endoscopically with minimal blood loss, short catheterization time and hospital stay.

Aged↗

PubMed2005

Potentiation of a dendritic cell vaccine for murine renal cell carcinoma by CpG oligonucleotides.

PURPOSE: An ideal vaccine therapy for tumors should activate both effector and memory immune responses against tumor-specific antigens. Here we investigated the effect of CpG oligodeoxynucleotides (CpG-ODN) for their ability to potentiate the activity of tumor antigen-pulsed bone marrow-derived dendritic cells (DC) in a vaccine model for the treatment of murine renal cell carcinoma (RENCA). EXPERIMENTAL DESIGN: First we evaluated the effects of a murine renal cell carcinoma (RENCA) on immune cell activity in a mouse model using in vitro assays for T-cell proliferation and natural killer cell activation. To overcome the immune suppression of the tumor, we s.c. injected groups of 10 mice with dendritic cells and tumor cells. We compared the effect of different conditioning regimens of the DCs with RENCA antigen and/or CpG-ODNs before injection by measuring tumor size twice a week. RESULTS: Tumor growth was shown to negatively affect spleen cell and T-cell proliferation, IFN-gamma production, natural killer cell activity, and NF-kappaB activation in T cells. In this model, we have shown that RENCA-pulsed CpG-ODN-treated DCs were able not only to significantly reduce tumor growth but also to prevent tumor implantation in 60% of mice. Tumor-free mice were resistant to tumor challenge and the immunity conferred by the vaccine was transferable and tumor specific. CONCLUSIONS: This data show that RENCA down-modulates the immune response, and DC vaccine therapy, in conjunction with CpG-ODN, can restore tumor-specific immunity.

Adjuvants, Immunologic↗

PubMed2005

Sacral neuromodulation: long-term experience of one center.

OBJECTIVES: To perform a retrospective analysis of the long-term results of our experience with neuromodulation. Our center has been involved in the early studies leading to approval of the NeuroStim system of neuromodulation for the treatment of patients presenting with refractory lower urinary symptoms of urgency/frequency with or without incontinence and chronic urinary retention. METHODS: A total of 52 patients have undergone implantation at our center since 1990 using very rigid criteria, including temporary percutaneous nerve evaluation for up to 7 days and a requirement of 50% improvement before consideration for implantation. Patients were followed up closely and a telephone questionnaire was conducted for those patients not seen in the previous 6 months. Of the 52 patients, 11 were not available for evaluation. Of the 41 remaining patients, 22 had urgency/frequency syndrome, 6 had urgency incontinence, 9 had urinary retention, and 4 had interstitial cystitis with intractable pelvic pain. RESULTS: Of the 41 patients, 5 required explantation. These 5 patients were offered reimplantation but declined. Of the 22 patients in the urgency/frequency group, 10 (45%) had persistent improvement. In the urgency incontinence group, 3 of the 6 patients required explantation, and 1 (17%) reported improvement in the frequency of incontinence episodes. Of the 9 patients in the chronic urinary retention group, 7 (78%) had improvement. CONCLUSIONS: The long-term (up to 13 years) results of neuromodulation in patients presenting with urgency/frequency with and without urge incontinence and urinary retention were reviewed. The long-term results in the first two groups were not maintained over time. The patients with chronic urinary retention, although a small sample, fared better.

Adolescent↗

PubMed2005

Holmium laser enucleation of prostate for patients in urinary retention.

OBJECTIVES: To evaluate holmium laser enucleation of the prostate in patients presenting in urinary retention secondary to benign prostatic hyperplasia. METHODS: From May 2000 to May 2004, 169 patients, with a mean age of 74 years, who presented in urinary retention secondary to benign prostatic hyperplasia underwent holmium laser enucleation of the prostate. The mean urinary volume drained at catheterization was 670 mL (range 132 to 2000). All the patients were assessed preoperatively, 1, 3, 6, and 12 months postoperatively, and every year thereafter. All the patients were evaluated by physical examination, digital rectal examination, symptom evaluation using the International Prostate Symptom Score questionnaire, uroflowmetry (whenever possible), postvoid residual urine volume measurement, and prostate-specific antigen. The mean preoperative prostate volume estimated by transrectal ultrasonography was 101 cm3 (range 20 to 351). RESULTS: The mean catheter time and hospital stay was 1.6 and 1.7 days, respectively. The peak urinary flow rate, postvoid residual urine volume, and International Prostate Symptom Score and quality-of-life score were significantly improved by 1 month after surgery and continued to improve during subsequent follow-up. Three patients (1.75%) were unable to void postoperatively; one required a suprapubic catheter and two used clean intermittent catheterization. Four patients (2.4%) were receiving anticoagulant therapy and required blood transfusion. Bladder neck contracture and urethral stricture developed in 1.7% and 1.2%, respectively. CONCLUSIONS: Holmium laser enucleation of the prostate represents a safe and effective treatment for patients with benign prostatic hyperplasia presenting in urinary retention. It has low morbidity and provides immediate symptom and voiding improvement.

Aged↗

PubMed2005

Holmium laser enucleation of the prostate: a size-independent new "gold standard".

We report our experience with holmium laser enucleation of the prostate (HoLEP) for treatment of 552 patients with symptomatic benign prostatic hyperplasia (BPH) and their long-term outcome. Between March 1998 and January 2005, a retrospective review was conducted at our institution of 552 cases in which patients underwent HoLEP. Patient characteristics, indications for surgery, preoperative and postoperative International Prostate Symptom Score (I-PSS), peak flow rate (Qmax), postvoid residual urine, operative data, catheterization time, hospital stay, and immediate and long-term complications were recorded. The mean age of patients was 73.7 +/- 7.9 years, and the mean follow-up time was 36 months. The mean preoperative prostate size was 83.7 +/- 49.7 cm3 (range, 20 to 351 cm3), the mean enucleation time was 86 minutes (range, 15 to 255 minutes), and the mean enucleated tissue weight was 52.1 +/- 43.7 g (range, 5 to 340 g). The voiding parameters were significantly improved, with a 200% increase in Qmax, as well as a 75% improvement in I-PSS at 1 year postoperatively, which continued to improve during subsequent follow-up. A total of 11 patients required blood transfusion; 8 of them were on anticoagulant therapy. Irritative symptoms were noted in 9.4% and transient stress incontinence in 4.2% of patients. Bladder neck contracture and urethral stricture each developed in 1.3% of patients. We conclude that HoLEP is a safe and effective procedure for treatment of symptomatic BPH, regardless of prostate size, with low morbidity and short hospital stay. HoLEP appears to be the modern alternative to transurethral resection of the prostate and open prostatectomy, and it may be considered a size-independent new "gold standard."

Aged↗

PubMed2005

Effects of M274773, a neurokinin-2 receptor antagonist, on bladder function in chronically spinalized rats.

PURPOSE: Increased afferent nerve activity may have an important role in the pathogenesis of neurogenic detrusor overactivity. We tested the efficacy of the neuokinin-2 receptor antagonist M274773 ((S)-N-[2-(3,4-Dichlorophenyl)-4-[4-(2-oxoperhydro-pyrimidin-l-yl) piperidino]butyl]-N-methylbenzamide dihydrochloride) on neurogenic detrusor overactivity after spinal cord injury in rats. MATERIALS AND METHODS: Included in this study were 48 adult Sprague-Dawley rats (Charles River, Montreal, Quebec, Canada). Six animals served as normal controls, while 32 underwent spinal cord transection at the 10th thoracic vertebra. Two weeks after spinal cord injury 6 animals underwent filling cystometrography to confirm neurogenic detrusor overactivity, while another 12 served as paraplegic controls. The remaining 24 paraplegic animals were used to test the drug and they were divided into 2 equal groups of 12. Group 1 received the drug at a dose of 0.3 mg/kg daily, while group 2 received a dose of 0.6 mg/kg daily. Each paraplegic control and treatment group was further subdivided into 2 subgroups of 6 rats each. In subgroup 1 filling cystometrography was done 3 weeks after spinal cord injury, while in subgroup 2 it was done 4 weeks after spinal cord injury. RESULTS: Three weeks after spinal cord injury neurogenic detrusor overactivity developed in all paraplegic control animals with a mean bladder capacity +/- SD of 0.7 +/- 0.2 ml and a mean voiding pressure of 59 +/- 14.2 cm H2O. Neurogenic detrusor overactivity resolved in 50% and 83% of the animals that received M274773 for 1 week at doses of 0.3 and 0.6 mg/kg daily, respectively. Mean cystometric bladder capacity was 1.2 +/- 0.5 vs 1.3 +/- 0.4 ml and mean voiding pressure was 46.1 +/- 10.8 vs 40 +/- 9.9 cm H2O in animals that received 0.3 vs 0.6 mg/kg daily, respectively. The drug produced better urodynamic results when given for 2 weeks rather than 1 week. CONCLUSIONS: M274773 is effective for neurogenic detrusor overactivity after spinal cord injury in the rat. It may provide an alternative clinical treatment option for neurogenic detrusor overactivity and urgency/frequency syndrome. This new neurokinin-2 selective antagonist has time and dose response effects, which further suggests the potential for clinical application.

Animals↗

PubMed2004

Erectile and urinary dysfunction after radical prostatectomy for prostate cancer in Quebec: a population-based study of 2415 men.

OBJECTIVE: To assess and quantify urinary and sexual function outcomes from a large scale cohort of Canadian men treated for localized prostate cancer. METHODS: A self-administered survey focusing on erectile (ED) and urinary dysfunction (UD) was completed by 2415 of 4546 men (response rate 53.1%) treated with prostatectomy for prostate cancer in the Province of Quebec between 1988 and 1996. The time between treatment and survey completion ranged from 17 months to 8.5 years. RESULTS: After prostatectomy, of 2227 men without ED before surgery, erections of adequate firmness for intercourse were reported by 25%. ED rate increased with age and ranged from 55% in men aged <60 years to 85% in men 75 years or older. Of all, 19.1% reported ED treatment. ED rate was significantly related to UD severity. Severe UD, quantified as urinary leakage exceeding one tablespoon, was reported by 6.6%. Severe UD rate ranged from 4% in men aged <60 years to 10% in men 75 years or older. Strictures were reported by 16.3% and were associated with a two-fold increase in severe UD rate (p<0.001). Finally, age and socioeconomic status represented important predictor variables in univariate and multivariate regression models. CONCLUSION: ED rate of 75% and severe UD rate of 6.6% could be anticipated after RP. These outcomes are similar to unselected large scale, patient reported outcomes from the United States.

Aged↗

PubMed2004

Holmium:YAG laser enucleation of the prostate: multimedia description from a trainee's perspective.

Adoption of holmium laser enucleation of the prostate has been limited by its difficult learning curve. To enhance training, digital video clips from four procedures were captured in MPEG-2 format and compiled into a PowerPoint file with professional narration. The two surgical techniques used--the two-lobe and three-lobe methods--are described with a focus on the technical details and common mistakes.

Humans↗

PubMed2003

Holmium Laser Enucleation of the Prostate (HoLEP): A Technical Update.

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this procedure. This paper provides an outline of the HoLEP technique as is currently used at two centers in hopes of easing the initial learning curve. TECHNICAL CONSIDERATIONS: Detailed descriptions of the major steps of the HoLEP procedure are provided with attention to critical steps such as identification of the surgical capsule, median and lateral lobe enucleation, and morcellation of enucleated tissue. CONCLUSIONS: HoLEP is a promising alternative for the surgical treatment of BPH which allows complete removal of intact lobes of the prostate. Obstruction is relieved immediately with superior hemostasis, no risk of TUR syndrome, and a minimal hospital stay.

Journal Article↗

PubMed2003

Familial prostate and breast cancer in men treated with prostatectomy for prostate cancer: a population based case-control study.

PURPOSE: We assessed familial prostate and breast cancer in Quebec. MATERIALS AND METHODS: Using a self-administered mail survey we assessed the prevalence of prostate and breast cancer in first degree relatives of 1,633 men treated with prostatectomy for prostate cancer in the province of Quebec and in first degree relatives of 1,386 spouse controls. RESULTS: The OR of familial breast cancer was 1.1 (95% CI 0.9 to 1.4). The OR of 3.0 (95% CI 2.5 to 3.6) recorded for prostate cancer was modified by francophone versus anglophone linguistic preference (OR 3.2, 95% CI 2.6, 3.9 versus 1.5, 95% CI 0.8 to 2.7, p = 0.02). Male sibship size was a statistically significant parameter modifying this association (p = 0.02), namely no brothers (OR 1.7, 95% CI 1.0 to 2.8), 1 or 2 (OR 3.1, 95% CI 2.2 to 4.3) and 3 or more (OR 3.9, 95% CI 2.9 to 5.2). Geographic regions of the province including and neighboring greater Montreal showed a lower OR than more peripheral regions (2.5, 95% CI 2.0 to 3.2 versus 4.1, 95% CI 2.9 to 5.7, p = 0.02). CONCLUSIONS: Francophone men with large male sibships residing in remote areas may be at higher risk for familial prostate cancer and represent the ideal target for further efforts to determine the genetic component of prostate cancer in Quebec.

Adult↗

PubMed2003

Cross-cultural validation of the UCLA prostate cancer index.

OBJECTIVES: To explore the impact of cross-cultural differences on University of California, Los Angeles, Prostate Cancer Index (PCI) reliability and validity, which is unknown. The PCI represents the most widely used prostate cancer-specific health-related quality-of-life assessment tool. METHODS: The PCI sexual and urinary scales, the RAND SF-36 survey, and the Prostate Outcomes Research Team (PORT) prostate cancer treatment complication profile were self-administered. The principal sample consisted of 2415 men (anglophone 256, francophone 2159) treated with radical prostatectomy in Quebec between 1988 and 1996. An additional 35 men (anglophone 17, francophone 18) formed the retest sample. RESULTS: The PCI demonstrated excellent internal consistency and test-retest reliability in tests based on the entire cohort and in tests addressing the two linguistically different groups. The instrument showed a lack of convergence with the SF-36 scales, confirming the distinctness of the generic and prostate cancer-specific constructs. The PCI sexual scales converged with the aggregate PORT sexual items (r = 0.8), and the PCI urinary scales were strongly related to the aggregate PORT urinary items (r = 0.7). Convergence between PCI urinary bother and function was strong (r = 0.8), but only moderate convergence was noted between PCI sexual bother and function (r = 0.4). The relation between bother and function in both urinary and sexual domains was weaker in anglophone participants relative to their francophone counterparts. CONCLUSIONS: The PCI is reliable and, at best, only modestly affected by cultural differences when administered to culturally distinct English-speaking men or when translated into French.

Cross-Cultural Comparison↗

PubMed2003

Benign prostatic hyperplasia: from A - Z.

The management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia over the last decade underwent many changes. The introduction of many medical options including alpha blockers and 5 alpha reductase inhibitors provided alternatives to what used to be surgery or "watchful waiting". Alpha blockers evolved over the years from non specific alpha 1, and 2 blockers to alpha 1 selective and then to alpha 1a selective with a wider acceptance due to lack of need to titrate and a better safety profile. 5 alpha reductase inhibitor (finasteride) passed through a lot of changes from being the first medication directed at treating the disease process to less acceptance because of time to response and early data supporting no added benefit when combined to alpha blockers for a short period. Longer studies now demonstrate a benefit to combination causing a reduction of progression parameters and an advantage over 4 years in reducing endpoints, namely acute urinary retention and surgery. Surgical options have also undergone many changes over the last decade with introduction of minimally invasive options as well as the introduction of new energy sources to reduce complications and allow for management of larger glands such as Holmium laser enucleation of the prostate or the use of bipolar loops. The journey has been long and exciting and we are sure Ernie Ramsey enjoyed being in the forefront of the evolution.

5-alpha Reductase Inhibitors↗

PubMed2002

Effects of ZD6169 and ZD0947, 2 potassium adenosine triphosphate channel openers, on bladder function of spinalized rats.

PURPOSE: The use of K+ channel openers is emerging as an attractive possibility for treating bladder overactivity. We tested the efficacy of the 2 adenosine triphosphate dependent K channel openers ZD6169 and ZD0947 on detrusor hyperreflexia after spinal cord injury in rats. MATERIALS AND METHODS: Included in this study were 72 adult Sprague-Dawley rats. Six animals served as normal controls, while 66 underwent spinal cord transection at the 10th thoracic vertebra. Two weeks after spinal cord injury 6 animals underwent filling cystometrography to confirm detrusor hyperreflexia, while another 12 served as control paraplegics. For each drug 24 animals were used and divided into 2 equal groups of 12. Group 1 received the drug in a dose of 3 mg./kg. daily, while group 2 received a dose of 0.3 mg./kg. daily. Each control paraplegic and treatment group was further subdivided into 2 subgroups of 6 rats. In subgroup 1 filling cystometrography was done 3 weeks after spinal cord injury, while in subgroup 2 it was done 4 weeks after spinal cord injury. RESULTS: Three weeks after spinal cord injury detrusor hyperreflexia developed in all control paraplegic animals with a mean bladder capacity plus or minus standard deviation of 0.7 +/- 0.2 ml. and a mean voiding pressure of 59 +/- 14.2 cm. water. Detrusor hyperreflexia resolved in 66% of the animals that received ZD6169 for 1 week at either dose. For example, mean bladder capacity was 2.5 +/- 1.8 versus 1.8 +/- 1.2 ml. and mean voiding pressure was 42.1 +/- 15.9 versus 43.2 +/- 21.4 cm. water in animals that received 3 versus 0.3 mg./kg. daily, respectively. All animals that received a dose of 3 mg./kg. ZD0947 daily for 1 week showed no detrusor hyperreflexia with a mean bladder capacity of 2.7 +/- 1.8 ml. and mean voiding pressure of 34 +/- 8.5 cm. water, while at 0.3 mg./kg. daily 83% showed no detrusor hyperreflexia with a mean bladder capacity of 2.5 +/- 2.0 ml. and a mean voiding pressure of 41.5 +/- 13.8 cm. water. Each drug produced better urodynamic results when given for 2 weeks. CONCLUSIONS: ZD6169 and ZD0947 are effective treatment for detrusor hyperreflexia after spinal cord injury and they may provide alternative treatment options for overactive bladder. Each drug has time and dose dependent response effects that reflect their wide range of efficacy. However, ZD0947 shows an efficacy profile that is relatively superior to that of ZD6169.

Amides↗